Provider Demographics
NPI:1154447324
Name:RIDGEWOOD MEDICAL GROUP LLP
Entity Type:Organization
Organization Name:RIDGEWOOD MEDICAL GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:HERBOWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-227-5157
Mailing Address - Street 1:2081 W RIDGE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2724
Mailing Address - Country:US
Mailing Address - Phone:585-227-4560
Mailing Address - Fax:585-227-4608
Practice Address - Street 1:2081 W RIDGE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2724
Practice Address - Country:US
Practice Address - Phone:585-227-4560
Practice Address - Fax:585-227-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY215928OtherLICENSE HERBOWY
NY132960OtherLICENSE HELLEMS
NYH69517Medicare UPIN
NY132960OtherLICENSE HELLEMS
NYC49604Medicare UPIN