Provider Demographics
NPI:1932647955
Name:CORNERSTONE URGENT CARE CENTER LLC
Entity Type:Organization
Organization Name:CORNERSTONE URGENT CARE CENTER LLC
Other - Org Name:CORNERSTONE URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIDOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-207-0088
Mailing Address - Street 1:2968 CHILI AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4532
Mailing Address - Country:US
Mailing Address - Phone:585-207-0088
Mailing Address - Fax:585-207-0092
Practice Address - Street 1:2968 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-4532
Practice Address - Country:US
Practice Address - Phone:585-207-0088
Practice Address - Fax:585-207-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132252-B261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care