Provider Demographics
NPI:1912099136
Name:NEUROLOGY ASSOCIATES OF ROCHESTER PC
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF ROCHESTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSIST
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-586-7550
Mailing Address - Street 1:20 HAGEN DR.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625
Mailing Address - Country:US
Mailing Address - Phone:585-586-7550
Mailing Address - Fax:585-586-7588
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:SUITE 575
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3038
Practice Address - Country:US
Practice Address - Phone:585-336-5336
Practice Address - Fax:585-336-5117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00731842Medicaid
NY02442015Medicaid
NY01018377Medicaid
NY00731842Medicaid
NY11681BMedicare ID - Type UnspecifiedAS MC #
NY01018377Medicaid
NY02442015Medicaid
NY11681DMedicare ID - Type UnspecifiedAG MC #
NYH93166Medicare UPIN