Individual
STACEY GOMBETTO I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
1425 PORTLAND AVE, TWIG MEDICAL GROUP, ROCHESTER, NY 14621-3001
(585) 922-2197
Mailing address
1425 PORTLAND AVE, TWIG MEDICAL GROUP, ROCHESTER, NY 14621-3001
(585) 922-2197
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004655
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02512545
—
NY
Enumeration date
06/22/2006
Last updated
10/27/2010
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