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Organization
IRONDEQUOIT INTERNAL MEDICINE
Active
Organization
IRONDEQUOIT INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARISA KHISHCHENKO M.D. (OWNER)
(585) 338-2530
Entity
Organization
Contact information
Practice address
485 TITUS AVE STE H, ROCHESTER, NY 14617-3544
(585) 338-2530
(585) 338-7304
Mailing address
485 TITUS AVE STE H, ROCHESTER, NY 14617-3544
(585) 338-2530
(585) 338-7304
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
180528
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01584647
—
NY
01
—
102621BJ
PREFERRED CARE
NY
Enumeration date
02/21/2007
Last updated
08/22/2020
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