Organization
BROCKPORT VINE MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEX FAHOURY MD (OWNER)
(585) 208-8668
Entity
Organization
Contact information
Practice address
122 WEST AVE STE 6, BROCKPORT, NY 14420-1225
(585) 208-8668
Mailing address
67 SARAH CIR, SPENCERPORT, NY 14559-9592
(585) 208-8668
(585) 617-4219
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
09/24/2019
Last updated
01/03/2020
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