Healthcare Provider Details

I. General information

NPI: 1881772895
Provider Name (Legal Business Name): ROCHESTER MOBILE X-RAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BUELL ROAD SUITE 14
ROCHESTER NY
14624-3134
US

IV. Provider business mailing address

1769 W 26TH ST
ERIE PA
16508-1256
US

V. Phone/Fax

Practice location:
  • Phone: 800-836-9729
  • Fax: 585-436-5340
Mailing address:
  • Phone: 814-459-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JACOB RUSSELL WUERSTLE
Title or Position: PRESIDENT
Credential:
Phone: 814-459-6280