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Organization

NEW YORK PHYSICAL MEDICINE CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LISA KEOUGH (CREDENTIALING SPECIALIST)
(405) 848-7974
Entity
Organization

Contact information

Practice address
1295 PORTLAND AVE, STE 9, ROCHESTER, NY 14621-2731
(585) 544-6410
(585) 544-9247
Mailing address
1295 PORTLAND AVE, STE 9, ROCHESTER, NY 14621-2731
(585) 544-6410
(585) 544-9247

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
239194
NY

Other

Enumeration date
05/09/2012
Last updated
05/09/2012
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