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Organization
PEDIATRIC CARDIOLOGY
Active
Organization
PEDIATRIC CARDIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL M HETTERICH (SENIOR DIRECTOR OF FINANCE URMFG)
(585) 756-4003
Entity
Organization
Contact information
Practice address
601 ELMWOOD AVE, BOX 635, ROCHESTER, NY 14642-0001
(585) 275-7787
(585) 275-2352
Mailing address
601 ELMWOOD AVE, BOX 635, ROCHESTER, NY 14642-0001
(585) 275-7787
(585) 275-2352
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
06/06/2006
Last updated
04/28/2025
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