Provider Demographics
NPI:1235140252
Name:ROCHESTER UROLOGY GROUP, PLLC
Entity Type:Organization
Organization Name:ROCHESTER UROLOGY GROUP, PLLC
Other - Org Name:CENTER FOR UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-227-4000
Mailing Address - Street 1:2615 CULVER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-1746
Mailing Address - Country:US
Mailing Address - Phone:585-336-5320
Mailing Address - Fax:585-336-9114
Practice Address - Street 1:2615 CULVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-1746
Practice Address - Country:US
Practice Address - Phone:585-336-5320
Practice Address - Fax:585-336-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty