UPSTATE KETAMINE CARE NPI 1710522875

NPI Information

NPI: 1710522875
Provider Name: UPSTATE KETAMINE CARE
Classification: Clinical Nurse Specialist - 364SP0808X
Entity Type: Organization

Specialization: Psychiatric/Mental Health

Address:
3300 MONROE AVE STE 319
ROCHESTER, NY
ZIP 14618
Phone: (585) 673-2319
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UPSTATE KETAMINE CARE is a psychiatric/mental health clinical nurse specialist in Rochester, NY. UPSTATE KETAMINE CARE NPI is 1710522875. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3300 MONROE AVE STE 319
ROCHESTER, NY
ZIP 14618-617
Phone: (585) 673-2319

The provider's authorized official is Jeffrey C Leathersich .
The authorized official title is Practice Administrator and has the following contact phone number (585) 673-2319.

The enumeration date for this NPI number is 11/13/2019 and was last updated on 11/13/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	364SP0808X	Clinical Nurse Specialist	Psychiatric/Mental Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	03426666	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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