Individual
TAYLOR J INDIVERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1415 PORTLAND AVE, ROCHESTER, NY 14621-3038
(585) 922-2906
(585) 922-2951
Mailing address
1415 PORTLAND AVE, ROCHESTER, NY 14621-3038
(585) 922-2906
(585) 922-2951
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03726107
—
NY
Enumeration date
09/17/2012
Last updated
03/04/2014
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