Organization
PEDIATRIC IMMUN-NEPHR-RHEUMOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL M HETTERICH (AUTHORIZED OFFICIAL)
(585) 756-4008
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
2080P0201X
Pediatric Allergy/Immunology Physician
—
—
2080P0210X
Pediatric Nephrology Physician
Primary
—
—
2080P0216X
Pediatric Rheumatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03033272
—
NY
Enumeration date
08/18/2006
Last updated
04/28/2025
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