Provider Demographics
NPI:1679541726
Name:ROCHESTER RADIOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:ROCHESTER RADIOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-922-3220
Mailing Address - Street 1:1415 PORTLAND AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3038
Mailing Address - Country:US
Mailing Address - Phone:585-336-5000
Mailing Address - Fax:585-336-5006
Practice Address - Street 1:1255 PORTLAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2713
Practice Address - Country:US
Practice Address - Phone:585-467-8346
Practice Address - Fax:585-336-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY463658Medicaid
NY463658Medicaid