Provider Demographics
NPI:1285818211
Name:ADVANCED FOOTCARE CENTER OF ROCHESTER
Entity type:Organization
Organization Name:ADVANCED FOOTCARE CENTER OF ROCHESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-249-0020
Mailing Address - Street 1:2828 BAIRD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1247
Mailing Address - Country:US
Mailing Address - Phone:585-249-0020
Mailing Address - Fax:585-586-4835
Practice Address - Street 1:2828 BAIRD RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1247
Practice Address - Country:US
Practice Address - Phone:585-249-0020
Practice Address - Fax:585-586-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003655332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies