Provider Demographics
NPI:1952353492
Name:SANBERG, IRINA S (RPAC)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:S
Last Name:SANBERG
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-3122
Mailing Address - Fax:585-922-1399
Practice Address - Street 1:101 CANAL LANDING BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5109
Practice Address - Country:US
Practice Address - Phone:585-239-7300
Practice Address - Fax:585-227-7723
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005820363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S57168Medicare UPIN
NYPA0020-BA0017 GROUPMedicare PIN