Provider Demographics
NPI:1659348332
Name:GASTROENTEROLOGY ASSOCIATES OF ROCHESTER, LLP
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF ROCHESTER, LLP
Other - Org Name:DRS MARK PEREIRA AND MANISH MADAN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREJ
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAPKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-720-1550
Mailing Address - Street 1:2440 RIDGEWAY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4145
Mailing Address - Country:US
Mailing Address - Phone:585-720-1550
Mailing Address - Fax:585-720-1553
Practice Address - Street 1:2440 RIDGEWAY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4145
Practice Address - Country:US
Practice Address - Phone:585-720-1550
Practice Address - Fax:585-720-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02101839Medicaid
AA0771OtherMEDICARE PTAN
NYAA0771Medicare ID - Type Unspecified
NY02101839Medicaid