Provider Demographics
NPI:1457464588
Name:GENESEE VALLEY CARDIOTHORACIC, PC
Entity Type:Organization
Organization Name:GENESEE VALLEY CARDIOTHORACIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KIRSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-544-6550
Mailing Address - Street 1:1415 PORTLAND AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3038
Mailing Address - Country:US
Mailing Address - Phone:585-544-6550
Mailing Address - Fax:585-338-2997
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3038
Practice Address - Country:US
Practice Address - Phone:585-544-6550
Practice Address - Fax:585-338-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01409443Medicaid
1457464588OtherNPI
NY01409443Medicaid
NY01409443Medicaid