Healthcare Provider Details

I. General information

NPI: 1780966721
Provider Name (Legal Business Name): EMILY A BLAIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY RIGONI

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 LONG POND RD
ROCHESTER NY
14626-4122
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-7281
  • Fax:
Mailing address:
  • Phone: 585-368-4788
  • Fax: 585-723-7280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number115111
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number015111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: