Provider Demographics
NPI:1598776957
Name:ROMESSER, COREY E (MD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:E
Last Name:ROMESSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SOUTH AVE
Mailing Address - Street 2:BOX 58
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2733
Mailing Address - Country:US
Mailing Address - Phone:585-341-6770
Mailing Address - Fax:585-341-8305
Practice Address - Street 1:1000 SOUTH AVE
Practice Address - Street 2:BOX 58
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2733
Practice Address - Country:US
Practice Address - Phone:585-341-6770
Practice Address - Fax:585-341-8305
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239209208M00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010239209OtherBLUE CHOICE
NY02885867Medicaid
NY206040BUOtherPREFERRED CARE
NY02885867Medicaid