National Provider Identifier
Spectrum Internal Medicine PLLC
Spectrum Internal Medicine PLLC is listed in the NPPES registry with a primary specialty of Primary Care Clinic/Center in Rochester, NY and a listed phone number of (646) 246-3674.
Profile Overview
- NPI
- 1518193713
- Provider Type
- Organization
- Primary Specialty
- Primary Care Clinic/Center
- Enumeration Date
- June 03, 2009
- Last Updated
- June 03, 2009
Practice Location
- 1445 Portland Ave
- Suite 302
- Rochester, NY 14621-3036
Phone: (646) 246-3674
Mailing Address
- PO Box 62
- Woodridge, NY 12789-0062
Specialties
- Primary Care Clinic/Center (261QP2300X)
Full Record
- NPI
- 1518193713
- Entity Type
- Organization
- EIN
- <UNAVAIL>
- Organization Name
- Spectrum Internal Medicine PLLC
- Mailing Street Address
- PO Box 62
- Mailing City
- Woodridge
- Mailing State
- NY
- Mailing ZIP Code
- 12789-0062
- Mailing Country
- US
- Practice Street Address
- 1445 Portland Ave
- Practice Address Line 2
- Suite 302
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14621-3036
- Practice Country
- US
- Practice Phone
- (646) 246-3674
- Enumeration Date
- June 03, 2009
- Last Updated
- June 03, 2009
- Authorized Official Last Name
- Goltz
- Authorized Official First Name
- Hayden
- Authorized Official Middle Name
- Randle
- Authorized Official Title
- Member
- Authorized Official Phone
- (646) 246-3674
- Organization Subpart
- No
- Authorized Official Name Prefix Text
- Dr.
- Authorized Official Credential Text
- D.O.
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Primary Care Clinic/Center (261QP2300X)