Healthcare Provider Details

I. General information

NPI: 1275989485
Provider Name (Legal Business Name): JAMES SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 07/07/2023
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LAC DE VILLE BLVD BLDG D
ROCHESTER NY
14618-5647
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 664
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5321
  • Fax:
Mailing address:
  • Phone: 585-275-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number308891
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number308891
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: