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General NPI Number Information
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NPI Number | 1588832984
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Entity Type | Organization
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Legal Business Name | NANETTE D PHILLIS, MD, PLLC
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 2365 S CLINTON AVE SUITE 100
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City | ROCHESTER
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State | NY
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Zip | 14618-2663
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Country | US
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Telephone | 585-461-9500
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Fax | 585-271-1432
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Provider Business Mailing Address
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Address Line | 2365 S CLINTON AVE SUITE 100
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City | ROCHESTER
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State | NY
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Zip | 14618-2663
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Country | US
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Telephone | 585-461-9500
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Fax | 585-271-1432
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. ANDREW OPHARDT
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Credential |
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Telephone | 585-755-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 195745
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License Number State | NY
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