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NPI Code Detail

MEDICARE: MS. JANICE MCKAE PA

MEDICARE: MS. JANICE MCKAE PA
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
1363A00000XPhysician Assistant3819NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1003918OTHERNYPA LICENSE

General Provider Information

NPI Number : 1508828559
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JANICE MCKAE PA
Provider Business Mailing Address
First Line : 2129 MONROE AVE
Second Line : 4
City : ROCHESTER
State : NY
Zip : 14618
Country : US
Telephone Number : 240-527-5750
Fax Number :
Provider Business Practice Location Address
First Line : 130 PLYMOUTH AVE S
Second Line : CCS
City : ROCHESTER
State : NY
Zip : 14614-2209
Country : US
Telephone Number : 585-753-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 06/08/2017

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