Provider Demographics
NPI:1700359726
Name:PEDIATRIC URGENT CARE OF ROCHESTER
Entity Type:Organization
Organization Name:PEDIATRIC URGENT CARE OF ROCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISANTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-807-7435
Mailing Address - Street 1:1800 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2749
Mailing Address - Country:US
Mailing Address - Phone:716-636-5437
Mailing Address - Fax:
Practice Address - Street 1:6687 PITTSFORD-PALMYRA RD
Practice Address - Street 2:SUITE 40
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1445
Practice Address - Country:US
Practice Address - Phone:716-636-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC AND ADOLESCENT URGENT CARE OF WESTERN NEW YORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-03
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty