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General NPI Number Information
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NPI Number | 1699021691
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Entity Type | Organization
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Legal Business Name | IGNITE WELLNESS MANAGEMENT SERVICES LLC
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 1150 PITTSFORD VICTOR RD STE G
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City | PITTSFORD
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State | NY
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Zip | 14534-3838
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Country | US
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Telephone | 585-248-8720
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 PITTSFORD VICTOR RD STE G
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City | PITTSFORD
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State | NY
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Zip | 14534-3838
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Country | US
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Telephone | 585-248-8720
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Fax |
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Authorized Official
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Title or Position | MEDICAL/LABORATORY DIRECTOR
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Name | DR. STEPHEN H COHEN
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Credential | M.D.
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Telephone | 585-248-8720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | T634
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License Number State | NY
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