Provider Demographics
NPI:1568609568
Name:IRONDEQUOIT PEDIATRICS
Entity Type:Organization
Organization Name:IRONDEQUOIT PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-266-0310
Mailing Address - Street 1:485 TITUS AVE STE F
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3544
Mailing Address - Country:US
Mailing Address - Phone:585-266-0310
Mailing Address - Fax:585-266-9207
Practice Address - Street 1:485 TITUS AVE STE F
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3544
Practice Address - Country:US
Practice Address - Phone:585-266-0310
Practice Address - Fax:585-266-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty