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NPI Code Detail

MEDICARE: ROCHESTER GENERAL LONG TERM CARE, INC

MEDICARE: ROCHESTER GENERAL LONG TERM CARE, INC
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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician
2363LA2200XAdult Health Nurse Practitioner
3363LF0000XFamily Nurse Practitioner
4363LG0600XGerontology Nurse Practitioner
5207R00000XInternal Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3CA0509OTHERNYRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OPB334OTHERNYPREFERRED CARE
2079OTHERNYBCBS

General Provider Information

NPI Number : 1194855619
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROCHESTER GENERAL LONG TERM CARE, INC
Provider Business Mailing Address
First Line : 1550 EMPIRE BLVD
Second Line :
City : WEBSTER
State : NY
Zip : 14580-2104
Country : US
Telephone Number : 585-617-4300
Fax Number :
Provider Business Practice Location Address
First Line : 1550 EMPIRE BLVD
Second Line :
City : WEBSTER
State : NY
Zip : 14580-2104
Country : US
Telephone Number : 585-617-4300
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : MR. JOHN MIDOLO
Credential :
Telephone Number : 585-922-1907
Provider Enumeration Date : 03/06/2007
Last Update Date : 09/21/2017

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