Provider Demographics
NPI:1518416031
Name:CANANDAIGUA TRINITY OB/GYN, PLLC
Entity Type:Organization
Organization Name:CANANDAIGUA TRINITY OB/GYN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANI
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHEHATA
Authorized Official - Suffix:
Authorized Official - Credentials:MBCHB (MD)
Authorized Official - Phone:607-731-8263
Mailing Address - Street 1:241 PARRISH ST STE B
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1784
Mailing Address - Country:US
Mailing Address - Phone:585-337-4335
Mailing Address - Fax:585-337-4336
Practice Address - Street 1:241 PARRISH ST STE B
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1784
Practice Address - Country:US
Practice Address - Phone:585-337-4335
Practice Address - Fax:585-337-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02579064Medicaid
H74810Medicare UPIN
RB 4572Medicare PIN