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General NPI Number Information
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NPI Number | 1063790608
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Entity Type | Organization
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Legal Business Name | WESTERN NEW YORK MEDICAL PRACTICE P.C.
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 1425 PORTLAND AVE
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City | ROCHESTER
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State | NY
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Zip | 14621-3001
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Country | US
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Telephone | 585-922-1318
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 PORTLAND AVE
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City | ROCHESTER
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State | NY
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Zip | 14621-3001
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Country | US
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Telephone | 585-922-1318
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Fax |
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Authorized Official
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Title or Position | SVP- FINANCE
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Name | PAULA TINCH
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Credential |
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Telephone | 585-922-1223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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