Provider Demographics
NPI:1104946714
Name:PITTSFORD MEDICAL, PC
Entity type:Organization
Organization Name:PITTSFORD MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:QUAIL
Authorized Official - Last Name:DAVIDOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-586-5140
Mailing Address - Street 1:3300 MONROE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4624
Mailing Address - Country:US
Mailing Address - Phone:585-586-5140
Mailing Address - Fax:585-586-7010
Practice Address - Street 1:3300 MONROE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4624
Practice Address - Country:US
Practice Address - Phone:585-586-5140
Practice Address - Fax:585-586-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty