Provider Demographics
NPI:1518400688
Name:ROCHESTER GENERAL HOSPITAL
Entity Type:Organization
Organization Name:ROCHESTER GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/EVP
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-5497
Mailing Address - Street 1:1425 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-426-1234
Mailing Address - Fax:585-247-2797
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-426-1234
Practice Address - Fax:585-247-2797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCHESTER GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-22
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D0654949291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory