Organization
MARY M. GOOLEY HEMOPHILIA CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM WILMARTH (PRESIDENT/CEO)
(585) 922-5700
Entity
Organization
Contact information
Practice address
1415 PORTLAND AVE, SUITE 500, ROCHESTER, NY 14621-3038
(585) 922-5700
(585) 922-5775
Mailing address
1415 PORTLAND AVE STE 500, ROCHESTER, NY 14621-3043
(585) 922-5700
(585) 922-5775
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
33D0705405
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000921985001
BCWNY/HEALTHNOW
NY
05
—
00355284
—
NY
01
—
014005944
BLUE CHOICE
NY
01
—
103346CJ
PREFERRED CARE
NY
01
—
50
BLUE CROSS
NY
01
—
5643168
AETNA
NY
Enumeration date
04/25/2006
Last updated
03/02/2021
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