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Organization
PEDIATRIC DEVELOPMENT CLINIC
Active
Organization
PEDIATRIC DEVELOPMENT CLINIC
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
Mailing address
601 ELMWOOD AVE, BOX 635, ROCHESTER, NY 14642-0001
(585) 275-7787
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
—
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03032491
—
NY
Enumeration date
06/22/2006
Last updated
03/09/2018
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