Healthcare Provider Details

I. General information

NPI: 1194059519
Provider Name (Legal Business Name): MRS. SARAH S. HOSSENLOPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HAGEN DR STE 120
ROCHESTER NY
14625-2658
US

IV. Provider business mailing address

1425 PORTLAND AVE
ROCHESTER NY
14621-3001
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-5300
  • Fax: 585-922-0450
Mailing address:
  • Phone: 585-922-0367
  • Fax: 585-922-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013605
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: