Provider Demographics
NPI:1649276676
Name:JURIK, JOHN
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:JURIK
Suffix:
Gender:M
Credentials:
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:585-697-6400
Mailing Address - Fax:585-342-9166
Practice Address - Street 1:1500 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3065
Practice Address - Country:US
Practice Address - Phone:585-697-6000
Practice Address - Fax:585-342-9166
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00631838Medicaid
NY00631838Medicaid