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General NPI Number Information
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NPI Number | 1912576034
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Entity Type | Organization
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Legal Business Name | HENRIETTA PEDIATRICS, PLLC
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 1200 JEFFERSON RD STE 115
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City | ROCHESTER
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State | NY
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Zip | 14623-3158
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Country | US
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Telephone | 585-601-2600
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Fax | 585-229-6008
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Provider Business Mailing Address
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Address Line | 10 LAWTON DR
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City | PITTSFORD
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State | NY
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Zip | 14534-3266
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Country | US
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Telephone | 585-451-7014
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. EMILIE ELLICOTT
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Credential | DO
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Telephone | 585-451-7014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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