Provider Demographics
NPI:1487911863
Name:WEST RIDGE OBSTETRICS & GYNECOLOGY, LLP
Entity type:Organization
Organization Name:WEST RIDGE OBSTETRICS & GYNECOLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LESTORTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-720-8900
Mailing Address - Street 1:3101 W RIDGE RD
Mailing Address - Street 2:BLDG D
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3249
Mailing Address - Country:US
Mailing Address - Phone:585-225-1580
Mailing Address - Fax:585-225-2040
Practice Address - Street 1:3101 W RIDGE RD
Practice Address - Street 2:BLDG D
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3249
Practice Address - Country:US
Practice Address - Phone:585-225-1580
Practice Address - Fax:585-225-2040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST RIDGE OBSTETRICS & GYNECOLOGY, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D2030621291U00000X
NY33D0884731291U00000X
NY33D0700602291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY207V00000XOtherTAXONOMY CODE MD
NY1992897409OtherTYPE 1 NPI #
NY363LX0001XOtherTAXONOMY CODE NP
NY207V00000XOtherTAXONOMY CODE MD