Provider Demographics
NPI:1407845415
Name:FINGER LAKES INTERNISTS
Entity Type:Organization
Organization Name:FINGER LAKES INTERNISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRUSIEVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-776-8032
Mailing Address - Street 1:7603 ROUTE 54
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-7930
Mailing Address - Country:US
Mailing Address - Phone:607-776-0163
Mailing Address - Fax:607-776-8032
Practice Address - Street 1:7603 ROUTE 54
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-7930
Practice Address - Country:US
Practice Address - Phone:607-776-0163
Practice Address - Fax:607-776-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02084559Medicaid
NYAA0506Medicare PIN