Provider Demographics
NPI:1649281189
Name:DILLENBECK, BRIAN D (PA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:DILLENBECK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 WESTFALL RD
Mailing Address - Street 2:STE A
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2611
Mailing Address - Country:US
Mailing Address - Phone:585-271-2022
Mailing Address - Fax:585-473-5864
Practice Address - Street 1:880 WESTFALL RD
Practice Address - Street 2:STE A
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2611
Practice Address - Country:US
Practice Address - Phone:585-271-2022
Practice Address - Fax:585-473-5864
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY3601363A00000X
NY003601-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP019003601OtherBLUE CHOICE
NY109072CUOtherPREFERRED CARE
CC5947Medicare PIN
PA1207Medicare PIN