Provider Demographics
NPI:1457580532
Name:DAY, BRIAN DEWAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DEWAYNE
Last Name:DAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3065
Mailing Address - Country:US
Mailing Address - Phone:585-697-6000
Mailing Address - Fax:585-342-9166
Practice Address - Street 1:2350 RIDGEWAY AVE STE A
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4127
Practice Address - Country:US
Practice Address - Phone:585-922-2440
Practice Address - Fax:585-663-3293
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA259723207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03631192Medicaid
NY01131126/RGHMedicaid
NYJ400091557Medicare PIN
NY70005A/RGHMedicare PIN