MEDICARE: JENNIFER H RICHMAN M.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	2084P0015X	Psychosomatic Medicine Physician	246740	NY
2	2084P0800X	Psychiatry Physician	246740	NY

General Provider Information

NPI Number	:	1861404857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER H RICHMAN M.D.

Provider Business Mailing Address
First Line	:	100 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5504
Country	:	US
Telephone Number	:	585-922-1900
Fax Number	:	585-922-0444

Provider Business Practice Location Address
First Line	:	490 E RIDGE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-1229
Country	:	US
Telephone Number	:	585-922-4395
Fax Number	:	585-922-5715

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	06/22/2023

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