Organization
PEDIATRIC NEONATAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN J HAIBACH (CFO)
(585) 756-4010
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
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00488940
—
NY
Enumeration date
08/14/2006
Last updated
05/04/2010
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