Provider Demographics
NPI:1255359147
Name:IMHOFF, LUCINDA (RPA-C)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:IMHOFF
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 KENDALL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-9701
Mailing Address - Country:US
Mailing Address - Phone:315-462-9482
Mailing Address - Fax:315-462-5438
Practice Address - Street 1:293 W NORTH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1530
Practice Address - Country:US
Practice Address - Phone:315-789-0993
Practice Address - Fax:315-789-0281
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005799363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01864906Medicaid
S37949Medicare UPIN
NY32989IMedicare PIN