UPSTATE KETAMINE CARE (NPI# 1710522875) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710522875 |
| Entity Type | Organization |
| Organization Name | UPSTATE KETAMINE CARE |
| Practice Address |
3300 Monroe Ave Ste 319 Rochester NY 14618-4617 |
| Practice Telephone | 5856732319 |
| Mailing Telephone | 5856732319 |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2019-11-13 |
| Authorized Official Name | JEFFREY C LEATHERSICH (PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 5856732319 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SP0808X |
Clinical Nurse Specialist Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 03426666 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | UPSTATE KETAMINE CARE, INC. | 3300 Monroe Avenue, Suite 328, Rochester, New York 14618 |
| Street Address |
3300 MONROE AVE STE 319 |
| City | ROCHESTER |
| State | NY |
| Zip Code | 14618-4617 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962056499 | Zahavi Dental of Rochester | Dentist | 1815 S. Clinton Ave, 510, Rocheter, NY 14618 | 2019-08-01 |
| 1760047278 | Inner Power Physical Therapy Pllc | Clinic/Center | 2561 Lac Deville Boulevard, Suite 100, Rochester, NY 14618 | 2019-05-09 |
| 1659859858 | Steven Sanfilippo | Counselor | 2000 S. Winton Rd., Building 4, Suite 303, Rochester, NY 14618 | 2018-07-31 |
| 1578064853 | Feet First Inc | Durable Medical Equipment & Medical Supplies | 1900 Clinton Ave S Ste 5, Rochester, NY 14618 | 2018-02-22 |
| 1558805374 | Jennifer Virella | Social Worker | 2000 South Winton Road, Bldg 2, Rochester, NY 14618 | 2016-12-13 |
| 1235589300 | Andrew Cyrus Marcy | Nurse Practitioner | 95 Allens Creek Road Bld 1 Ste 306, Rochester, NY 14618 | 2016-06-20 |
| 1932561073 | Legacy Pediatrics | Pediatrics | 1815 South Clinton Avenue Ste 360, Rochester, NY 14618 | 2016-03-28 |
| 1790143105 | Marie Lynn Bieber | Dietitian, Registered | 919 Winton Rd S Ste 220, Rochester, NY 14618 | 2016-02-01 |
| 1720443096 | Brittany Rose Masetta | Marriage & Family Therapist | 2000 S Winton Rd, Bldg 4, Suite #200, Rochester, NY 14618 | 2015-12-30 |
| 1437543097 | Kathleen Skye Kemp | Internal Medicine | 2400 S Clinton Ave Ste G2, Rochester, NY 14618 | 2015-03-22 |
| Find all providers in zip 14618 | ||||
| Taxonomy Code | 364SP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063864395 | Sherryl St.martin | Clinical Nurse Specialist | 3101 Superior Dr Nw, Rochester, MN 55901-1993 | 2016-07-11 |
| 1235507161 | Sandra G Witmer | Clinical Nurse Specialist | 300 Crittenden Blvd, Rochester, NY 14642-0001 | 2015-09-09 |
| 1215239140 | Elizabeth L. Pestka | Clinical Nurse Specialist | 200 1st St Sw, Rochester, MN 55905-0001 | 2010-11-29 |
| 1205968708 | Ann Koranda | Clinical Nurse Specialist | 1500 1st Ave Ne, Suite 213, Rochester, MN 55906-4170 | 2007-03-10 |
| 1336276575 | Ann Koranda | Clinical Nurse Specialist | 1500 1st Ave Ne, Suite 213, Rochester, MN 55906-4170 | 2007-02-27 |
| 1134281090 | Joy Marie Alexander | Clinical Nurse Specialist | 1932 Viking Dr Nw, Rochester, MN 55901 | 2006-12-15 |
| 1356379028 | Rosetta A. Harrell | Clinical Nurse Specialist | 401 E 8th St, Ste. A, Rochester, IN 46975-1443 | 2006-06-29 |
| 1376517482 | Pamela J Nelson | Clinical Nurse Specialist | 200 1st St Sw, Rochester, MN 55905-0001 | 2006-02-15 |
| 1497733836 | Judith R Nishimura | Clinical Nurse Specialist | 200 1st St Sw, Rochester, MN 55905-0001 | 2006-01-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245862804 | Empire Np Psychiatric Care, Pllc | Clinical Nurse Specialist | 22 Nottingham Way, Cohoes, NY 12047-4972 | 2020-02-11 |
| 1083840383 | Deborah Maxine Torres | Clinical Nurse Specialist | 184 Quaspeck Blvd, Valley Cottage, NY 10989-2428 | 2009-06-02 |
| 1306043203 | John Charles Azzopardi | Clinical Nurse Specialist | 220 E 87th St, Office Suite L.a., New York, NY 10128-3127 | 2007-07-02 |
| 1033268453 | Laura Kleinerman | Clinical Nurse Specialist | 156 West 86th Street, 1c, New York, NY 10024-4029 | 2007-01-09 |
| 1437250206 | Nancy C Seddio | Clinical Nurse Specialist | 39 Nippon Ave, Staten Island, NY 10312 | 2006-09-26 |
| 1295761070 | Beth A. Vandenberg | Clinical Nurse Specialist | 580 Pleasant View Dr, Lancaster, NY 14086-1404 | 2006-06-24 |
| 1457337404 | Lynn D Mitchell | Clinical Nurse Specialist | 629 W Main St, Riverhead, NY 11901-2842 | 2005-12-21 |
| 1124625074 | Danielle Damas | Clinical Nurse Specialist | 455 Tarrytown Rd Ste 1594, White Plains, NY 10607-1313 | 2020-10-05 |
| 1790303543 | Mary F Drost | Clinical Nurse Specialist | 155 Indian Head Rd, Commack, NY 11725-2212 | 2020-07-08 |
| 1487133294 | Jjgnp In Adult Health, P.C. | Clinical Nurse Specialist | 77 Shore Rd, Mount Sinai, NY 11766-1419 | 2018-08-13 |
| Find all providers with the same taxonomy | ||||
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| 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.