Provider Demographics
NPI:1013977982
Name:SIROTENKO, GEORGE ALEXIS (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALEXIS
Last Name:SIROTENKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 SENATOR KEATING BLVD
Mailing Address - Street 2:BLDG E SUITE 3100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-473-1750
Mailing Address - Fax:585-473-4806
Practice Address - Street 1:995 SENATOR KEATING BLVD
Practice Address - Street 2:BLDG E SUITE 3100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-473-1750
Practice Address - Fax:585-473-4806
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198671207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01674097Medicaid
G21445Medicare UPIN
NY14356CMedicare ID - Type Unspecified