Provider Demographics
NPI:1225043706
Name:RED CREEK ORTHOPAEDICS PC
Entity type:Organization
Organization Name:RED CREEK ORTHOPAEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-321-0110
Mailing Address - Street 1:67 KENDALL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-9701
Mailing Address - Country:US
Mailing Address - Phone:315-462-9482
Mailing Address - Fax:315-462-5438
Practice Address - Street 1:125 RED CREEK DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4272
Practice Address - Country:US
Practice Address - Phone:585-321-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0594Medicare PIN