Provider Demographics
NPI:1083027296
Name:ROCHESTER MEDICAL WEIGHT LOSS, P.C
Entity Type:Organization
Organization Name:ROCHESTER MEDICAL WEIGHT LOSS, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GULE-RANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-467-9790
Mailing Address - Street 1:1299 PORTLAND AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2730
Mailing Address - Country:US
Mailing Address - Phone:585-467-9790
Mailing Address - Fax:585-467-9798
Practice Address - Street 1:1299 PORTLAND AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2730
Practice Address - Country:US
Practice Address - Phone:585-467-9790
Practice Address - Fax:585-467-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190081173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01649816Medicaid
NY01649816Medicaid