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General NPI Number Information
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NPI Number | 1063094688
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Entity Type | Organization
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Legal Business Name | JESSICA KURZDORFER NURSE PRACTITIONER IN PSYCHIATRY PC
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 95 ALLENS CREEK RD STE 330
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City | ROCHESTER
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State | NY
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Zip | 14618-3246
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Country | US
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Telephone | 585-360-7554
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Fax | 949-577-4708
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Provider Business Mailing Address
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Address Line | 59 ROWLEY ST
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City | ROCHESTER
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State | NY
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Zip | 14607-2630
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Country | US
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Telephone | 585-360-7554
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Fax | 949-577-4708
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Authorized Official
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Title or Position | NURSE PRACTITIONER/PRESIDENT
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Name | SEAN KURZDORFER
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Credential | PMHNP
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Telephone | 585-360-7554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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