Individual
THERESA E ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2350 RIDGEWAY AVE, SUITE A, ROCHESTER, NY 14626-4112
(585) 225-0410
(585) 225-1921
Mailing address
2350 RIDGEWAY AVE, SUITE A, ROCHESTER, NY 14626-4112
(585) 225-0410
(585) 225-1921
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
003727
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02625845
—
NY
Enumeration date
03/02/2006
Last updated
01/27/2010
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