Provider Demographics
NPI:1598731135
Name:BRANCHE, GREGORY J (PA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:BRANCHE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 CLINTON AVE S STE 530
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5721
Mailing Address - Country:US
Mailing Address - Phone:585-442-4310
Mailing Address - Fax:585-442-6750
Practice Address - Street 1:1815 CLINTON AVE S STE 530
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5721
Practice Address - Country:US
Practice Address - Phone:585-442-4310
Practice Address - Fax:585-442-6750
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006425-1363A00000X
NYMB0511217363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH70031Medicare ID - Type Unspecified
NYS41321Medicare UPIN