Provider Demographics
NPI:1013337039
Name:ROCHESTER PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:ROCHESTER PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:REDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-218-2022
Mailing Address - Street 1:40 OFFICE PKWY
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1738
Mailing Address - Country:US
Mailing Address - Phone:585-218-2022
Mailing Address - Fax:646-706-0095
Practice Address - Street 1:40 OFFICE PKWY
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1738
Practice Address - Country:US
Practice Address - Phone:585-218-2022
Practice Address - Fax:646-706-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2136302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1821027426OtherNPI