Healthcare Provider Details

I. General information

NPI: 1376973453
Provider Name (Legal Business Name): SUSAN REITZ LEDNAR RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 ALEXANDER ST 5000
ROCHESTER NY
14607-4039
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-8004
  • Fax:
Mailing address:
  • Phone: 585-922-1469
  • Fax: 585-922-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003692-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: