=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609882042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIGESTIVE DISEASE ASSOCIATES LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1561 LONG POND RD STE 110
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-723-1510
-----------------------------------------------------
Fax | 585-723-1518
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1561 LONG POND RD STE 110
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-723-1510
-----------------------------------------------------
Fax | 585-723-1518
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR PARTNER
-----------------------------------------------------
Name | DR. JOSEPH N DYTOC
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 585-723-1510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 197367
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------