Provider Demographics
NPI:1821030529
Name:UNIVERSITY OF ROCHESTER INTERNAL MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:UNIVERSITY OF ROCHESTER INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR FINANCE AND ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MARTAIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAIBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-273-4607
Mailing Address - Street 1:200 WHITE SPRUCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1605
Mailing Address - Country:US
Mailing Address - Phone:585-424-5990
Mailing Address - Fax:585-424-1013
Practice Address - Street 1:200 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1605
Practice Address - Country:US
Practice Address - Phone:585-424-5990
Practice Address - Fax:585-424-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0710Medicare ID - Type Unspecified