Provider Demographics
NPI:1942265343
Name:PRYHUBER, KEITH GERARD (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:GERARD
Last Name:PRYHUBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 HELENDALE RD
Mailing Address - Street 2:SUITE 90
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-3173
Mailing Address - Country:US
Mailing Address - Phone:585-288-0530
Mailing Address - Fax:585-288-3363
Practice Address - Street 1:500 HELENDALE RD
Practice Address - Street 2:SUITE 90
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-3173
Practice Address - Country:US
Practice Address - Phone:585-288-0530
Practice Address - Fax:585-288-3363
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169326207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010133641Medicaid
NY169326OtherNY STATE LICENSE NO
NYP010169326OtherBLUE CROSS/BLUE SHIELD
NYP010169326OtherEXCELLUS PROVIDER NO
NY101174CDOtherPREFERRED CARE NO
NY010133641Medicaid
NYP010169326OtherBLUE CROSS/BLUE SHIELD