Healthcare Provider Details

I. General information

NPI: 1013206978
Provider Name (Legal Business Name): JENNIFER LYNN EMRICH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN SASSANO

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RED CREEK DR STE 100
ROCHESTER NY
14623-5261
US

IV. Provider business mailing address

200 RED CREEK DR SUITE 100
ROCHESTER NY
14623
US

V. Phone/Fax

Practice location:
  • Phone: 585-334-0130
  • Fax: 585-334-0213
Mailing address:
  • Phone: 585-334-0130
  • Fax: 585-334-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014686
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number14686
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: