| Spectrum Internal Medicine Pllc | |
|
1445 Portland Ave Suite 302 Rochester NY 14621-3036 | |
| (646) 246-3674 | |
| Not Available |
| Full Name | Spectrum Internal Medicine Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1445 Portland Ave, Rochester, New York |
| Authorized Official Name and Position | Hayden Randle Goltz (MEMBER) |
| Authorized Official Contact | 6462463674 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectrum Internal Medicine Pllc Po Box 62 Woodridge NY 12789-0062 Ph: () - | Spectrum Internal Medicine Pllc 1445 Portland Ave Suite 302 Rochester NY 14621-3036 Ph: (646) 246-3674 |
| NPI Number | 1518193713 |
|---|---|
| Provider Enumeration Date | 06/03/2009 |
| Last Update Date | 06/03/2009 |
| Medicare PECOS PAC ID | 0042362501 |
|---|---|
| Medicare Enrollment ID | O20090714000286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518193713 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 226840 (New York) | Primary |
| Provider Name | Hayden R Goltz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144202482 PECOS PAC ID: 7517951023 Enrollment ID: I20040408000952 |
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