Provider Demographics
NPI:1346258241
Name:MUHLBAUER DERMATOPATHOLOGY PC
Entity Type:Organization
Organization Name:MUHLBAUER DERMATOPATHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MUHLBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-586-5166
Mailing Address - Street 1:PO BOX 23930
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14692
Mailing Address - Country:US
Mailing Address - Phone:585-586-5166
Mailing Address - Fax:585-586-1370
Practice Address - Street 1:61 MONROE AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534
Practice Address - Country:US
Practice Address - Phone:585-586-5166
Practice Address - Fax:585-586-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCL017OtherPREFERRED CARE
NY00823996Medicaid
NYPO14939759OtherBLUE CHOICE
NY17660BMedicare ID - Type Unspecified