Individual
JACOB WILLIAM RAIFSTANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
2655 RIDGEWAY AVE STE 460, ROCHESTER, NY 14626-4296
(585) 581-6790
(585) 581-6793
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
(585) 922-1900
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
017837
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03957908
—
NY
Enumeration date
07/01/2014
Last updated
01/11/2023
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