Provider Demographics
NPI:1770732984
Name:LOYOLA MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:LOYOLA MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARTRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-451-8011
Mailing Address - Street 1:1160 PITTSFORD VICTOR RD STE G
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3825
Mailing Address - Country:US
Mailing Address - Phone:585-203-1005
Mailing Address - Fax:585-203-1013
Practice Address - Street 1:1160 PITTSFORD VICTOR RD STE G
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3825
Practice Address - Country:US
Practice Address - Phone:585-203-1005
Practice Address - Fax:585-203-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099098207QA0401X
NY2226262084P0800X
NY114313207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty