Provider Demographics
NPI:1710967534
Name:ROCHESTER CARDIOPULMONARY GROUP, P.C.
Entity Type:Organization
Organization Name:ROCHESTER CARDIOPULMONARY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IHOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:TROJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-6100
Mailing Address - Street 1:30 HAGEN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2658
Mailing Address - Country:US
Mailing Address - Phone:585-338-2700
Mailing Address - Fax:585-338-2738
Practice Address - Street 1:30 HAGEN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2658
Practice Address - Country:US
Practice Address - Phone:585-338-2700
Practice Address - Fax:585-338-2738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200770893OtherMVP
NY101894Medicaid
6890OtherBLUE SHIELD
180309590OtherBLUE CHOICE
16668AMedicare ID - Type Unspecified