National Provider Identifier

Brockport Vine Medical PC

Brockport Vine Medical PC is listed in the NPPES registry with a primary specialty of Internal Medicine Physician in Brockport, NY and a listed phone number of (585) 208-8668.

NPI 1871144543Brockport, NYInternal Medicine Physician

Source: public NPPES record, last updated January 03, 2020. This profile is informational and is not medical advice, a quality rating, or a provider recommendation.

Profile Overview

NPI
1871144543
Provider Type
Organization
Primary Specialty
Internal Medicine Physician
Enumeration Date
September 24, 2019
Last Updated
January 03, 2020

Practice Location

  • 122 West Ave Ste 6
  • Brockport, NY 14420-1225

Phone: (585) 208-8668

Mailing Address

  • 67 Sarah Cir
  • Spencerport, NY 14559-9592

Authorized Official

Name
Dr. Alex Fahoury
Title
Owner
Credentials
MD
Phone
(585) 208-8668

Specialties

  • Internal Medicine Physician (207R00000X)

Browse Similar Providers

See more Internal Medicine providers in Brockport, NY.

Open Internal Medicine providers in Brockport, NY

Full Record
NPI
1871144543
Entity Type
Organization
EIN
<UNAVAIL>
Organization Name
Brockport Vine Medical PC
Mailing Street Address
67 Sarah Cir
Mailing City
Spencerport
Mailing State
NY
Mailing ZIP Code
14559-9592
Mailing Country
US
Mailing Phone
(585) 208-8668
Mailing Fax
(585) 617-4219
Practice Street Address
122 West Ave Ste 6
Practice City
Brockport
Practice State
NY
Practice ZIP Code
14420-1225
Practice Country
US
Practice Phone
(585) 208-8668
Enumeration Date
September 24, 2019
Last Updated
January 03, 2020
Authorized Official Last Name
Fahoury
Authorized Official First Name
Alex
Authorized Official Title
Owner
Authorized Official Phone
(585) 208-8668
Organization Subpart
No
Authorized Official Name Prefix Text
Dr.
Authorized Official Credential Text
MD
Taxonomy Group 1
193400000X Single Specialty Group
Certification Date
January 03, 2020
updated_by_file
npidata_pfile_20050523-20260308.csv
Taxonomies
Internal Medicine Physician (207R00000X)