Provider Demographics
NPI:1508828559
Name:MCKAE, JANICE (PA)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:MCKAE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 MONROE AVE
Mailing Address - Street 2:4
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:240-527-5750
Mailing Address - Fax:
Practice Address - Street 1:130 PLYMOUTH AVE S
Practice Address - Street 2:CCS
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-2209
Practice Address - Country:US
Practice Address - Phone:585-753-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003918OtherPA LICENSE