Provider Demographics
NPI:1609996859
Name:REACH PROGRAM
Entity type:Organization
Organization Name:REACH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-275-7787
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 635
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-7787
Mailing Address - Fax:585-275-2352
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 635
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-7787
Practice Address - Fax:585-275-2352
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC GROUP OF THE UNIVERSITY OF ROCHESTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-30
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY104511DLOtherPREFERRED CARE