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General NPI Number Information
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NPI Number | 1326275892
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Entity Type | Organization
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Legal Business Name | STEVE B. PARK M.D. PC
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 485 TITUS AVE STE A
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City | ROCHESTER
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State | NY
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Zip | 14617-3544
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Country | US
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Telephone | 585-266-7880
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Fax | 585-266-5177
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Provider Business Mailing Address
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Address Line | 2300 BUFFALO ROAD BLDG 700
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City | ROCHESTER
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State | NY
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Zip | 14624-1367
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Country | US
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Telephone | 585-328-0153
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Fax | 585-328-0158
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Authorized Official
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Title or Position | OWNER
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Name | STEVE B PARK
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Credential | M.D.
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Telephone | 585-328-0153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | NY
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