Provider Demographics
NPI:1013380823
Name:ROCHESTER LIFESTYLE MEDICINE PLLC
Entity Type:Organization
Organization Name:ROCHESTER LIFESTYLE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-533-1368
Mailing Address - Street 1:PO BOX 22844
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14692-2844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1441 EAST AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1665
Practice Address - Country:US
Practice Address - Phone:585-484-1254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty