Provider Demographics
NPI:1023085198
Name:REDDECK, CYNTHIA R (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:R
Last Name:REDDECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAGEN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2658
Mailing Address - Country:US
Mailing Address - Phone:585-338-2700
Mailing Address - Fax:585-242-9663
Practice Address - Street 1:30 HAGEN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2658
Practice Address - Country:US
Practice Address - Phone:585-338-2700
Practice Address - Fax:585-242-9663
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145964207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
301123OtherWELLCARE
0079536OtherGHI
MD437DOtherPREFERRED CARE
64449285OtherTRICARE/CHAMPUS
4266389OtherAETNA
RC60145964OtherRCIPA
000524205002OtherHEALTH NOW LINDEN OAKS
6890OtherBCBS
PO10145964OtherEXCELLUS
PO10145964OtherGRIPA
NY00637687Medicaid
6890OtherBCBS
PO10145964OtherEXCELLUS