Healthcare Provider Details

I. General information

NPI: 1972421055
Provider Name (Legal Business Name): JOHN GRIFFIN NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 HIGHLAND AVE
ROCHESTER NY
14620-3024
US

IV. Provider business mailing address

1 PENN PLZ FL 19
NEW YORK NY
10119-1915
US

V. Phone/Fax

Practice location:
  • Phone: 585-760-1300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number313011
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: