Healthcare Provider Details

I. General information

NPI: 1487911863
Provider Name (Legal Business Name): WEST RIDGE OBSTETRICS & GYNECOLOGY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 W RIDGE RD BLDG D
ROCHESTER NY
14626-3249
US

IV. Provider business mailing address

3101 W RIDGE RD BLDG D
ROCHESTER NY
14626-3249
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-1580
  • Fax: 585-225-2040
Mailing address:
  • Phone: 585-225-1580
  • Fax: 585-225-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number33D2030621
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number33D0884731
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number33D0700602
License Number StateNY

VIII. Authorized Official

Name: CHRISTOPHER J LESTORTI
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 585-720-8900