Provider Demographics
NPI:1255524310
Name:BERNEDETTE P MINNELLA MD PLLC
Entity type:Organization
Organization Name:BERNEDETTE P MINNELLA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BERNEDETTE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MINNELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-697-7040
Mailing Address - Street 1:300 WHITE SPRUCE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1606
Mailing Address - Country:US
Mailing Address - Phone:585-697-7040
Mailing Address - Fax:
Practice Address - Street 1:300 WHITE SPRUCE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1606
Practice Address - Country:US
Practice Address - Phone:585-697-7040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239507-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1145Medicare PIN