Organization
PED PHYSICAL DISABILITIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER KNEBEL (BILLING MANAGER)
(585) 275-7787
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
207T00000X
Neurological Surgery Physician
Primary
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
—
—
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00512758
—
NY
Enumeration date
06/14/2006
Last updated
09/11/2025
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