# PEDIATRIC IMMUN-NEPHR-RHEUMOLOGY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205940152
- **Authorized official:** JILL M HETTERICH (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (585) 756-4008

## Contact information

- **Practice address:** 601 ELMWOOD AVE, BOX 635, ROCHESTER, NY 14642-0001
- **Practice address phone:** (585) 275-7787
- **Mailing address:** 601 ELMWOOD AVE, BOX 635, ROCHESTER, NY 14642-0001
- **Mailing address phone:** (585) 275-7787

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080P0201X | Pediatric Allergy/Immunology Physician | — | NULL | — |
| 2080P0201X | Pediatric Allergy/Immunology Physician | — | — | — |
| 2080P0210X | Pediatric Nephrology Physician | — | NULL | Yes |
| 2080P0210X | Pediatric Nephrology Physician | — | — | Yes |
| 2080P0216X | Pediatric Rheumatology Physician | — | NULL | — |
| 2080P0216X | Pediatric Rheumatology Physician | — | — | — |

## Other

- **Enumeration date:** 08/18/2006
- **Last updated:** 04/28/2025