Healthcare Provider Details

I. General information

NPI: 1073515839
Provider Name (Legal Business Name): JAMES A KRESGE RPAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N UNION ST SUITE 105
ROCHESTER NY
14607-1345
US

IV. Provider business mailing address

30 N UNION ST SUITE 105
ROCHESTER NY
14607-1345
US

V. Phone/Fax

Practice location:
  • Phone: 585-232-8940
  • Fax: 585-232-8687
Mailing address:
  • Phone: 585-232-8940
  • Fax: 585-232-8687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010961
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number001096-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: