Provider Demographics
NPI:1962469387
Name:KILIMNICK, JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:KILIMNICK
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 1:39 GOODMAN ST N
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1501
Mailing Address - Country:US
Mailing Address - Phone:585-271-2937
Mailing Address - Fax:585-271-3575
Practice Address - Street 1:39 GOODMAN ST N
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1501
Practice Address - Country:US
Practice Address - Phone:585-271-2937
Practice Address - Fax:585-271-3575
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210155-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010210155OtherBLUE CHOICE
NY01881025Medicaid
NY102957OtherPREFERRED CARE