Provider Demographics
NPI:1689634081
Name:OGNIBENE, STEVEN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOHN
Last Name:OGNIBENE
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 1:600 RED CREEK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4300
Mailing Address - Country:US
Mailing Address - Phone:585-244-5670
Mailing Address - Fax:585-338-1477
Practice Address - Street 1:600 RED CREEK DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4300
Practice Address - Country:US
Practice Address - Phone:585-244-5670
Practice Address - Fax:585-338-1477
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219206208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMDJ173OtherPREFERRED CARE
NY02687781Medicaid
NY7982650OtherAETNA
NYP010219206OtherBLUES
NY7982650OtherAETNA