Provider Demographics
NPI:1043745037
Name:RORY P HOUGHTALEN MD PLLC
Entity Type:Organization
Organization Name:RORY P HOUGHTALEN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:RORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOUGHTALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-586-1600
Mailing Address - Street 1:1584 SCRIBNER RD
Mailing Address - Street 2:PENFIELD
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-9752
Mailing Address - Country:US
Mailing Address - Phone:585-586-1600
Mailing Address - Fax:585-586-7951
Practice Address - Street 1:100 LINDEN OAKS
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2840
Practice Address - Country:US
Practice Address - Phone:585-586-1600
Practice Address - Fax:585-586-7951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1689142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty