BROCKPORT VINE MEDICAL PC (NPI# 1871144543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871144543 |
| Entity Type | Organization |
| Organization Name | BROCKPORT VINE MEDICAL PC |
| Practice Address |
122 West Ave Ste 6 Brockport NY 14420-1225 |
| Mailing Address |
67 Sarah Cir Spencerport NY 14559-9592 |
| Practice Telephone | 5852088668 |
| Mailing Telephone | 5852088668 |
| Mailing Fax Number | 5856174219 |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2020-01-03 |
| Authorized Official Name | DR. ALEX FAHOURY (OWNER) |
| Authorized Official Telephone | 5852088668 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| VINE MEDICAL GROUP | Doing Business As Name - Organization |
| Street Address |
122 WEST AVE STE 6 |
| City | BROCKPORT |
| State | NY |
| Zip Code | 14420-1225 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194217471 | Brianna Lynn Bunch | Licensed Practical Nurse | 126 White Road, Brockport, NY 14420 | 2018-06-03 |
| 1174012785 | Penny Bowers | Massage Therapist | 27 Market Street, Upstairs, Brockport, NY 14420 | 2018-05-09 |
| 1386172062 | Allison Manly | Dentist | 1000 Transit Way, Brockport, NY 14420 | 2017-05-25 |
| 1235518143 | Erin B Chapman | Physical Medicine & Rehabilitation | 350 New Campus Drive, Brockport, NY 14420 | 2015-05-26 |
| 1972853653 | Theresa Fox Lehman | Specialist | 32 Mission Hill Drive, Brockport, NY 14420 | 2012-09-11 |
| 1689946303 | Beverly Whiteman | Registered Nurse | 40 Allen St., Brockport, NY 14420 | 2012-01-27 |
| 1316217425 | Julie Ann Knapp | Registered Nurse | 40 Allen Street, Brockport Central School District, Brockport, NY 14420 | 2012-01-05 |
| 1851678965 | Jennifer Anne Cohen | Registered Nurse | 188 Utica Street, Brockport, NY 14420 | 2011-11-03 |
| 1205088960 | Amy Maureen Hennessy | Obstetrics & Gynecology | 6668 Fourth Section Rd Ste 500, Brockport, NY 14420 | 2008-10-14 |
| 1053454884 | Nancy S Iafrati | Nurse Practitioner | Suny Brockport Student Health Center, 350 New Campus Drive, Brockport, NY 14420 | 2007-02-14 |
| Find all providers in zip 14420 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144434408 | Brockport Internal Medicine, PC | Internal Medicine | 34 West Ave, Brockport, NY 14420-1304 | 2007-05-09 |
| 1043269335 | Pankaj Garg | Internal Medicine | 80 West Ave, Suite 109, Brockport, NY 14420-1322 | 2006-05-06 |
| 1942271218 | Didem Miraloglu | Internal Medicine | 156 West Ave, Suite 106, Brockport, NY 14420-1229 | 2006-01-27 |
| 1083939722 | Internal Medicine At Lakeside | Internal Medicine | 156 West Ave, Suite 106, Brockport, NY 14420-1229 | 2010-04-06 |
| 1619014420 | Christina Faig William | Internal Medicine | 156 West Ave, 2nd Floor, Brockport, NY 14420-1229 | 2007-01-31 |
| 1962555854 | Lakeside Hospital Internal Medicine Group | Internal Medicine | 156 West Ave, Brockport, NY 14420-1229 | 2007-01-22 |
| 1306868633 | Raj Mehta | Internal Medicine | 170 West Ave, Brockport, NY 14420-1227 | 2006-07-24 |
| 1568481786 | Rajendra Mehta and Leena Mehta Physicians PC | Internal Medicine | 80 West Ave, Brockport, NY 14420-1322 | 2006-07-19 |
| 1871518480 | Karori Mal Aggarwal | Internal Medicine | 156 West Ave, Ste 100, Brockport, NY 14420-1229 | 2006-07-13 |
| 1467406934 | Alex Ibrahim Fahoury | Internal Medicine | 156 West Ave, Brockport, NY 14420-1229 | 2006-05-20 |
| Find all providers in BROCKPORT | ||||
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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.