PEDIATRICS & ADOLESCENT MEDICINE GROUP NPI 1104861772

NPI Information

NPI: 1104861772
Provider Name: PEDIATRICS & ADOLESCENT MEDICINE GROUP
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

Address:
601 ELMWOOD AVE
BOX 635
ROCHESTER, NY
ZIP 14642
Phone: (585) 275-7787
Get Directions

PEDIATRICS & ADOLESCENT MEDICINE GROUP is an adolescent medicine pediatrics in Rochester, NY. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. PEDIATRICS & ADOLESCENT MEDICINE GROUP NPI is 1104861772. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

601 ELMWOOD AVE
BOX 635
ROCHESTER, NY
ZIP 14642-001
Phone: (585) 275-7787
Fax: (585) 275-2352

The provider's authorized official is Jill M Hetterich .
The authorized official title is Senior Director Of Finance Urmfg and has the following contact phone number (585) 756-4008.

The enumeration date for this NPI number is 6/18/2006 and was last updated on 8/9/2022.

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	103TC2200X	Psychologist	Clinical Child & Adolescent			No
2	2080A0000X	Pediatrics	Adolescent Medicine			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	00485887	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: 4/28/2024

NPI Synchronization or Removal

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