Provider Demographics
NPI:1851736060
Name:GOERGEN, ABBY (PA)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:GOERGEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:LEISHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-424-6770
Mailing Address - Fax:585-424-6776
Practice Address - Street 1:2250 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2706
Practice Address - Country:US
Practice Address - Phone:585-424-6770
Practice Address - Fax:585-424-6776
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4755363AS0400X
363AS0400X
NY025035363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06168152Medicaid