Provider Demographics
NPI:1093865701
Name:RIDGEWOOD MED-PEDS, LLP
Entity type:Organization
Organization Name:RIDGEWOOD MED-PEDS, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:COWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-255-1700
Mailing Address - Street 1:3101 RIDGE RD W
Mailing Address - Street 2:BUILDING C
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3249
Mailing Address - Country:US
Mailing Address - Phone:585-225-1700
Mailing Address - Fax:585-225-1439
Practice Address - Street 1:3101 RIDGE RD W
Practice Address - Street 2:BUILDING C
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3249
Practice Address - Country:US
Practice Address - Phone:585-225-1700
Practice Address - Fax:585-225-1439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208000000X, 207R00000X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty