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Individual

BRYAN J STANISTREET

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3101 W RIDGE RD BLDG C, ROCHESTER, NY 14626
(585) 225-1700
(585) 225-1439
Mailing address
3101 W RIDGE RD BLDG C, ROCHESTER, NY 14626-3249
(585) 225-1700
(585) 225-1439

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
276576
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
04450506
NY
Enumeration date
04/03/2012
Last updated
09/02/2020
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