Provider Demographics
NPI:1144286246
Name:BRIGHTON MEDICINE ASSOC PC
Entity type:Organization
Organization Name:BRIGHTON MEDICINE ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LON
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-473-1750
Mailing Address - Street 1:995 SENATOR KEATING BLVD
Mailing Address - Street 2:BLDG E STE 3100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-473-1750
Mailing Address - Fax:585-473-4806
Practice Address - Street 1:995 SENATOR KEATING BLVD
Practice Address - Street 2:BLDG E STE 3100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-473-1750
Practice Address - Fax:585-473-4806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01929262Medicaid
NY01929262Medicaid