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NPI Code Detail

MEDICARE: BRIAN DANIEL HENDRICKSON DO

MEDICARE: BRIAN DANIEL HENDRICKSON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician339380NY

General Provider Information

NPI Number : 1053057885
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN DANIEL HENDRICKSON DO
Provider Business Mailing Address
First Line : 100 KINGS HWY S
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-5504
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 211 E MAIN ST
Second Line :
City : BATAVIA
State : NY
Zip : 14020-2231
Country : US
Telephone Number : 585-815-6760
Fax Number : 585-344-7370
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2022
Last Update Date : 10/08/2025

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