MEDICARE: DR. LARRY MEDWETSKY PH.D.

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
1	231H00000X	Audiologist	001298-1	NY

General Provider Information

NPI Number	:	1144287194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY MEDWETSKY PH.D.

Provider Business Mailing Address
First Line	:	1000 ELMWOOD AVENUE
Second Line	:	400
City	:	ROCHESTER
State	:	NY
Zip	:	14620-3092
Country	:	US
Telephone Number	:	585-271-0680
Fax Number	:	585-442-4114

Provider Business Practice Location Address
First Line	:	1000 ELMWOOD AVENUE
Second Line	:	400
City	:	ROCHESTER
State	:	NY
Zip	:	14620-3092
Country	:	US
Telephone Number	:	585-271-0680
Fax Number	:	585-442-4114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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