Provider Demographics
NPI:1316117849
Name:PITTSFORD INTERNAL MEDICINE, LLC
Entity type:Organization
Organization Name:PITTSFORD INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-586-9290
Mailing Address - Street 1:59 MONROE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1308
Mailing Address - Country:US
Mailing Address - Phone:585-586-9290
Mailing Address - Fax:
Practice Address - Street 1:59 MONROE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1308
Practice Address - Country:US
Practice Address - Phone:585-586-9290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201279-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0501Medicare PIN