Provider Demographics
NPI:1073885836
Name:TOBI BERCHEN, MD
Entity Type:Organization
Organization Name:TOBI BERCHEN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TOBI
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:BERCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-243-4041
Mailing Address - Street 1:4638 GENESEE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1090
Mailing Address - Country:US
Mailing Address - Phone:585-243-4041
Mailing Address - Fax:585-243-5415
Practice Address - Street 1:4638 GENESEE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1090
Practice Address - Country:US
Practice Address - Phone:585-243-4041
Practice Address - Fax:585-243-5415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2289162080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty