Provider Demographics
NPI:1902852908
Name:GREATER ROCHESTER NEUROLOGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:GREATER ROCHESTER NEUROLOGICAL ASSOCIATES, PC
Other - Org Name:GREATER ROCHESTER NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-546-3265
Mailing Address - Street 1:2101 LAC DE VILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5643
Mailing Address - Country:US
Mailing Address - Phone:585-546-3265
Mailing Address - Fax:585-232-5158
Practice Address - Street 1:2101 LAC DE VILLE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5643
Practice Address - Country:US
Practice Address - Phone:585-546-3265
Practice Address - Fax:585-232-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03974898Medicaid
NY11990FOtherMEDICARE
NY01642644Medicaid
NY231421OtherNYS LICENSE
NY011640OtherNYS LICENSE
NY04899634Medicaid
NY02785486Medicaid
NY245745OtherNYS LICENSE
NYRB8433OtherMEDICARE
NY009552OtherNYS LICENSE
NY02909722Medicaid
NY1400028666OtherMEDICARE
NY199685-1OtherNYS LICENSE
NYP98714OtherMEDICARE
NYRB0576OtherMEDICARE
NYRB8434OtherMEDICARE