Provider Demographics
NPI:1891183679
Name:ST FINGER LAKES MEDICAL PLLC
Entity Type:Organization
Organization Name:ST FINGER LAKES MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUNINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-247-2000
Mailing Address - Street 1:2211 LYELL AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-5743
Mailing Address - Country:US
Mailing Address - Phone:585-247-2000
Mailing Address - Fax:585-247-2004
Practice Address - Street 1:2211 LYELL AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5743
Practice Address - Country:US
Practice Address - Phone:585-247-2000
Practice Address - Fax:585-247-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2412422081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02924936Medicaid