Provider Demographics
NPI:1639133044
Name:CONIGLIO, JOHN URBAN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:URBAN
Last Name:CONIGLIO
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 1:1065 SENATOR KEATING BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2600
Mailing Address - Country:US
Mailing Address - Phone:585-256-3550
Mailing Address - Fax:585-256-3554
Practice Address - Street 1:1065 SENATOR KEATING BOULEVARD
Practice Address - Street 2:SUITE 240
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-256-3550
Practice Address - Fax:585-256-3554
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166760207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01246524Medicaid
NY10284BMedicare ID - Type Unspecified
NYE54865Medicare UPIN