Provider Demographics
NPI:1265911002
Name:ROCHESTER RADIOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:ROCHESTER RADIOLOGY ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:VAN SICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-467-7441
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-0708
Mailing Address - Country:US
Mailing Address - Phone:585-267-7510
Mailing Address - Fax:585-267-7511
Practice Address - Street 1:127 NORTH ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1631
Practice Address - Country:US
Practice Address - Phone:585-344-5225
Practice Address - Fax:525-267-7511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCHESTER RADIOLOGY ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty