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General NPI Number Information
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NPI Number | 1407240682
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Entity Type | Individual
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Provider Name | SUSAN R. GRODENSKY M.S.O.M., LAC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 26 AZALEA RD
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City | ROCHESTER
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State | NY
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Zip | 14620-3020
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Country | US
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Telephone | 585-369-6850
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Fax | 585-319-4108
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Provider Business Mailing Address
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Address Line | 1 W MAIN ST
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City | HONEOYE FALLS
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State | NY
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Zip | 14472-1101
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Country | US
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Telephone | 585-369-6850
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Fax | 585-319-4108
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 002226
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License Number State | NY
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