Provider Demographics
NPI:1427565613
Name:LEGACY PEDIATRICS LLC
Entity Type:Organization
Organization Name:LEGACY PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-568-8330
Mailing Address - Street 1:1815 CLINTON AVE S STE 360
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5725
Mailing Address - Country:US
Mailing Address - Phone:585-568-8330
Mailing Address - Fax:585-568-8327
Practice Address - Street 1:1815 CLINTON AVE S STE 360
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5725
Practice Address - Country:US
Practice Address - Phone:585-568-8330
Practice Address - Fax:585-568-8327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty