=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912981333
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANNE LOUISE DELSIGNORE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2005
-----------------------------------------------------
Last Update Date | 04/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 LINDEN OAKS SUITE 210
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14625-2814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-641-0141
-----------------------------------------------------
Fax | 585-641-0140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 LINDEN OAKS SUITE 210
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14625-2814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-641-0141
-----------------------------------------------------
Fax | 585-641-0140
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 156054-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------