Healthcare Provider Details

I. General information

NPI: 1144858952
Provider Name (Legal Business Name): JESSICA CLAIRE O'CONNOR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 LONG POND RD STE 302
ROCHESTER NY
14626-4135
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-1120
  • Fax: 585-723-1776
Mailing address:
  • Phone: 585-723-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number025943
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: