Provider Demographics
NPI:1972568699
Name:FAIRPORT PEDIATRICS
Entity Type:Organization
Organization Name:FAIRPORT PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SAUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SOKOLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-223-0137
Mailing Address - Street 1:460 CROSSKEYS OFFICE PARK
Mailing Address - Street 2:FAIRPORT PEDIATRICS
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450
Mailing Address - Country:US
Mailing Address - Phone:585-223-6111
Mailing Address - Fax:585-223-0878
Practice Address - Street 1:460 CROSSKEYS OFFICE PARK
Practice Address - Street 2:FAIRPORT PEDIATRICS
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450
Practice Address - Country:US
Practice Address - Phone:585-223-6111
Practice Address - Fax:585-223-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty