Provider Demographics
NPI:1508452228
Name:PERFORMANCE HEALTH OF ROCHESTER
Entity Type:Organization
Organization Name:PERFORMANCE HEALTH OF ROCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:INGUI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-264-9126
Mailing Address - Street 1:46 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1864
Mailing Address - Country:US
Mailing Address - Phone:201-962-9066
Mailing Address - Fax:
Practice Address - Street 1:103 CANAL LANDING BLVD STE 10
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5108
Practice Address - Country:US
Practice Address - Phone:201-962-9066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124419486OtherNPI