Provider Demographics
NPI:1518185073
Name:ST JOHN FISHER COLLEGE
Entity type:Organization
Organization Name:ST JOHN FISHER COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF WELLNESS CENTER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:585-385-8000
Mailing Address - Street 1:1211 WOODHULL RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9156
Mailing Address - Country:US
Mailing Address - Phone:585-265-3849
Mailing Address - Fax:
Practice Address - Street 1:3690 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3537
Practice Address - Country:US
Practice Address - Phone:585-385-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330465261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health