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General NPI Number Information
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NPI Number | 1013952688
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ALLERGY OF PULMONARY
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 601 ELMWOOD AVE BOX 635
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City | ROCHESTER
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State | NY
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Zip | 14642-0001
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Country | US
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Telephone | 585-275-7787
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Fax | 585-275-2352
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Provider Business Mailing Address
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Address Line | 601 ELMWOOD AVE BOX 635
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City | ROCHESTER
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State | NY
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Zip | 14642-0001
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Country | US
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Telephone | 585-275-7787
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Fax | 585-275-2352
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Authorized Official
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Title or Position | CFO
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Name | MARTIN J HAIBACH
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Credential |
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Telephone | 585-756-4010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number |
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License Number State |
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