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NPI Code Detail

MEDICARE: ROOPA M KORNI PHYSICIAN PLLC

MEDICARE: ROOPA M KORNI PHYSICIAN PLLC
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 Physician253455NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21265776181OTHERNYMEDICAIRE NPI

General Provider Information

NPI Number : 1265776181
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROOPA M KORNI PHYSICIAN PLLC
Provider Business Mailing Address
First Line : 2450 W RIDGE RD
Second Line : SUITE 202
City : ROCHESTER
State : NY
Zip : 14626-3037
Country : US
Telephone Number : 585-413-3520
Fax Number : 585-360-4181
Provider Business Practice Location Address
First Line : 2450 W RIDGE RD
Second Line : SUITE 202
City : ROCHESTER
State : NY
Zip : 14626-3037
Country : US
Telephone Number : 585-413-3520
Fax Number : 585-360-4181
Authorized Official
Title or Position : DOCTOR
Name : DR. ROOPA KORNI
Credential : MD
Telephone Number : 585-413-3520
Provider Enumeration Date : 11/15/2012
Last Update Date : 11/01/2016

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1144536939 — AMANDA J DIAZ LCSW
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Directions to “ROOPA M KORNI PHYSICIAN PLLC ” Practice Location

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