Provider Demographics
NPI:1932370897
Name:PITTSFORD FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:PITTSFORD FAMILY MEDICINE PLLC
Other - Org Name:PITTSFORD FAMILY MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:585-662-5680
Mailing Address - Street 1:135 SULLYS TRL
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4564
Mailing Address - Country:US
Mailing Address - Phone:585-662-5680
Mailing Address - Fax:585-662-5679
Practice Address - Street 1:135 SULLYS TRL
Practice Address - Street 2:SUITE 7
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4564
Practice Address - Country:US
Practice Address - Phone:585-662-5680
Practice Address - Fax:585-662-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243056261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548283518OtherINDIVIDUAL NPI #
NY7484951OtherAETNA PROVIDER ID