Provider Demographics
NPI:1508885583
Name:CANANDAIGUA ORTHOPAEDIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:CANANDAIGUA ORTHOPAEDIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:585-394-1960
Mailing Address - Street 1:514 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2203
Mailing Address - Country:US
Mailing Address - Phone:585-394-1960
Mailing Address - Fax:585-393-9232
Practice Address - Street 1:229 PARRISH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1791
Practice Address - Country:US
Practice Address - Phone:585-394-1960
Practice Address - Fax:585-393-9232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0058034OtherGHI
NY01149577Medicaid
NY0186584370OtherEXCELLUS ROCHESTER MANAGE
NY923295002OtherHEALTHNOW
NY13975AMedicare ID - Type Unspecified