Provider Demographics
NPI:1356309157
Name:FALKOVICH, RUVIM (MD)
Entity Type:Individual
Prefix:
First Name:RUVIM
Middle Name:
Last Name:FALKOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HIGHWAY SOUTH
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-1304
Mailing Address - Fax:585-922-1399
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-338-4941
Practice Address - Fax:585-467-4626
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203879208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050915000065OtherFIDELIS CARE #
NY00027282401OtherUNIVERA #
NY00355266Medicaid
NY101666DLOtherPREFERRED CARE #
NY1214011OtherIHA #
NYP010203879OtherBLUE CHOICE #
NY00027282401OtherUNIVERA #
NY050915000065OtherFIDELIS CARE #