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General NPI Number Information
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NPI Number | 1427145184
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Entity Type | Individual
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Provider Name | GENNARO MARC POLVERINO MD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 30 HAGEN DR STE 300
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City | ROCHESTER
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State | NY
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Zip | 14625-2658
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Country | US
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Telephone | 585-922-0151
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Fax |
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Provider Business Mailing Address
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Address Line | 100 KINGS HWY S
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City | ROCHESTER
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State | NY
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Zip | 14617-5504
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Country | US
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Telephone | 585-368-3531
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Fax | 585-368-3747
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 272834
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 272834
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License Number State | NY
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