Provider Demographics
NPI:1427198993
Name:ROONEY, PAUL ALEXANDER (LAC, MAC,)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALEXANDER
Last Name:ROONEY
Suffix:
Gender:M
Credentials:LAC, MAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 VILLAGE TRL
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1416
Mailing Address - Country:US
Mailing Address - Phone:585-720-0250
Mailing Address - Fax:585-720-0054
Practice Address - Street 1:2300 RIDGE RD W
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2800
Practice Address - Country:US
Practice Address - Phone:585-720-0250
Practice Address - Fax:585-720-0054
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000847171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY156885GBOtherPREFERRED CARE HMO