Healthcare Provider Details

I. General information

NPI: 1154834877
Provider Name (Legal Business Name): WESTERN NEW YORK MEDICAL PRACTICE P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 LONG POND RD
ROCHESTER NY
14612-3057
US

IV. Provider business mailing address

470 LONG POND RD
ROCHESTER NY
14612-3057
US

V. Phone/Fax

Practice location:
  • Phone: 585-338-1200
  • Fax:
Mailing address:
  • Phone: 585-338-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA PATTON
Title or Position: MANAGER PROVIDER ENROLLMENT
Credential: RN
Phone: 585-922-0527