JACOB WILLIAM RAIFSTANGER


Address: 2655 Ridgeway Ave Ste 460, Rochester, NY 14626-4296
Phone: 5855816790

JACOB WILLIAM RAIFSTANGER (NPI# 1679989479) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1679989479
Entity Type Individual
Full Name JACOB WILLIAM RAIFSTANGER
Credential PHYSICIAN ASSISTANT
Practice Address 2655 Ridgeway Ave Ste 460
Rochester
NY 14626-4296
Mailing Address 100 Kings Hwy S
Rochester
NY 14617-5504
Practice Telephone 5855816790
Practice Fax Number 5855816793
Mailing Telephone 5859221900
Enumeration Date 2014-07-01
Last Update Date 2019-08-06
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AS0400X Physician Assistant
Specialization: Surgical Technologist
017837 NY Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
NY 03957908 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
1425 Portland Ave, Rochester, NY 146213001 5859223458

Office Location

Street Address 2655 RIDGEWAY AVE STE 460
City ROCHESTER
State NY
Zip Code 14626-4296

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NPI Name Taxonomy Address Enumeration
1760978084 Elizabeth M Neenan Nurse Practitioner 105 Canal Landing Blvd. Suite 1, Rochester, NY 14626 2018-07-10
1811488737 Anthony Richard Mesolella Dentist 2081 W Ridge Rd Ste 204, Rochester, NY 14626 2018-05-26
1285157370 Heather Kate Byam Nurse Anesthetist, Certified Registered 280 Mill Road, Rochester, NY 14626 2017-07-20
1710415039 Abner O De Los Santos Dentist 120 Erie Canal Dr Ste 150, Rochester, NY 14626 2017-05-31
1609308709 Ulfat Shafiq Dentist 1100 Long Pond Rd Ste 115, Greece, NY 14626 2017-03-29
1174982953 S.a.v.o.c L.l.c Preferred Provider Organization 2833 West Ridge Road, Pearle Vision Ridgemont Plaza Suite 'a', Rochester, NY 14626 2016-02-22
1700244357 Kerri Anne Sawyer Registered Nurse 82 Southridge Drive, Rochester, NY 14626 2016-02-10
1518398106 Braces of Greece Exclusive Provider Organization 770 Fetzner Rd., Rochester, NY 14626 2013-12-06
1477983443 Amy Pawlyk Licensed Practical Nurse 116 Annie Lane, Rochester, NY 14626 2013-11-12
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Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1518411107 Michelle Ann Swider Physician Assistant 1425 Portland Ave Ste 220, Rochester, NY 14621-3011 2016-08-11
1124423355 Amanda Schnorf Physician Assistant 2824 W Ridge Rd, Rochester, NY 14626-1639 2014-10-30
1225385305 Katie Elizabeth Kenny Physician Assistant 1555 Long Pond Rd Fl 1, Rochester, NY 14626-4122 2012-08-08
1558683904 Oswaldo Serge Physician Assistant 4036 3rd St Nw, Rochester, MN 55901-7564 2010-02-25
1417288945 Amanda Kay Johnson Physician Assistant 201 W Center St Ei-01 Surgical Assistant, Rochester, MN 55902-3003 2010-01-22
1033322797 Joan Marie Wobig Physician Assistant 5426 15th St Se, Rochester, MN 55904-6719 2007-05-08
1871705749 Beverley Myers Physician Assistant 4730 17th St Se, Rochester, MN 55904-6680 2007-05-04
1831310739 Brenda Gerdts Physician Assistant 4838 Scenic View Dr Sw, Rochester, MN 55902-1527 2007-05-01
1558419739 Kathryn Ann Ciurca Physician Assistant 868 Clover St, Rochester, NY 14610-3232 2007-01-06
1245265594 Margaret M Casper Physician Assistant 1445 Portland Ave Ste 210, Rochester, NY 14621-3008 2006-07-12
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Competitor

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City ROCHESTER
Zip Code 14626

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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