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General NPI Number Information
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NPI Number | 1265911002
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Entity Type | Organization
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Legal Business Name | ROCHESTER RADIOLOGY ASSOCIATES PC
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 127 NORTH ST
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City | BATAVIA
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State | NY
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Zip | 14020-1631
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Country | US
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Telephone | 585-344-5225
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Fax | 525-267-7511
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Provider Business Mailing Address
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Address Line | PO BOX 708
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City | PITTSFORD
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State | NY
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Zip | 14534-0708
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Country | US
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Telephone | 585-267-7510
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Fax | 585-267-7511
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | KENNETH N VAN SICKEL
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Credential | MD
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Telephone | 585-467-7441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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