Provider Demographics
NPI:1265776181
Name:ROOPA M KORNI PHYSICIAN PLLC
Entity type:Organization
Organization Name:ROOPA M KORNI PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROOPA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-413-3520
Mailing Address - Street 1:2450 W RIDGE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3037
Mailing Address - Country:US
Mailing Address - Phone:585-413-3520
Mailing Address - Fax:585-360-4181
Practice Address - Street 1:2450 W RIDGE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3037
Practice Address - Country:US
Practice Address - Phone:585-413-3520
Practice Address - Fax:585-360-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03127759Medicaid
NY1265776181OtherMEDICAIRE NPI