Organization
PODIATRY AFFILIATE OF ROCHESTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ELLIE JR. DPM (CEO/PRESIDENT)
(585) 642-6100
Entity
Organization
Contact information
Practice address
1500 PORTLAND AVENUE, PODIATRY/MEDICAL SUITE, ROCHESTER, NY 14621-3065
(585) 642-6100
(585) 642-6111
Mailing address
1500 PORTLAND AVENUE, PODIATRY SUITE, ROCHESTER, NY 14621-3065
(585) 642-6100
(585) 642-6111
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05448155
—
NY
Enumeration date
11/07/2017
Last updated
03/14/2022
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