Provider Demographics
NPI:1770901399
Name:TRIANTAFILOU, JOHN (RPA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:TRIANTAFILOU
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 619-716
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-3158
Mailing Address - Fax:585-275-8861
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 619-716
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-3158
Practice Address - Fax:585-275-8861
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17377363A00000X
NY017377-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant