Healthcare Provider Details

I. General information

NPI: 1285290650
Provider Name (Legal Business Name): GABRIELLA LOGRONO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2019
Last Update Date: 07/17/2023
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVENUE BOX MED
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

270 EXCHANGE BLVD APT 231
ROCHESTER NY
14608-2770
US

V. Phone/Fax

Practice location:
  • Phone: 585-285-2724
  • Fax:
Mailing address:
  • Phone: 954-294-2824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number313592
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number313592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: