Provider Demographics
NPI:1255592945
Name:CARRILLO, JORGE F (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:F
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 668
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-2691
Mailing Address - Fax:585-424-8707
Practice Address - Street 1:500 RED CREEK DR
Practice Address - Street 2:STE 110
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-487-3420
Practice Address - Fax:585-334-1264
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2012-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY265682207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400076226Medicare PIN
NYJ400076225Medicare PIN