Healthcare Provider Details

I. General information

NPI: 1760915995
Provider Name (Legal Business Name): IRIE TRANSPORTATION ASSOCIATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8-B BRADBURN ST,
ROCHESTER NY
14619
US

IV. Provider business mailing address

8-B BRADBURN ST.
ROCHESTER NY
14619
US

V. Phone/Fax

Practice location:
  • Phone: 585-797-5333
  • Fax:
Mailing address:
  • Phone: 585-797-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number838931898
License Number StateNY

VIII. Authorized Official

Name: RICHARD ANTHONY COWANS
Title or Position: OWNER
Credential:
Phone: 585-797-5333