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NPI Code Detail

MEDICARE: JUSTIN BERNARD VAIDA

MEDICARE: JUSTIN BERNARD VAIDA
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
1207X00000XOrthopaedic Surgery Physician89581SC
2207XX0801XOrthopaedic Trauma Physician330589NY

General Provider Information

NPI Number : 1407388168
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN BERNARD VAIDA
Provider Business Mailing Address
First Line : 601 ELMWOOD AVE BOX 665
Second Line :
City : ROCHESTER
State : NY
Zip : 14642-0001
Country : US
Telephone Number : 585-275-5321
Fax Number :
Provider Business Practice Location Address
First Line : 10 MIRACLE MILE DR
Second Line :
City : ROCHESTER
State : NY
Zip : 14623-5851
Country : US
Telephone Number : 585-275-5321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2017
Last Update Date : 09/13/2024

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