Provider Demographics
NPI:1457305872
Name:FINGER LAKES PREMIER MEDICAL HEALTH
Entity Type:Organization
Organization Name:FINGER LAKES PREMIER MEDICAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUCHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-787-5071
Mailing Address - Street 1:790 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2716
Mailing Address - Country:US
Mailing Address - Phone:585-385-9030
Mailing Address - Fax:585-385-9124
Practice Address - Street 1:821 PRE EMPTION RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2061
Practice Address - Country:US
Practice Address - Phone:315-787-5071
Practice Address - Fax:315-787-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168696207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC9468Medicare ID - Type Unspecified