Basic Information
| Provider Information | |||||||||
| NPI: | 1346258241 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MUHLBAUER DERMATOPATHOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23930 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855865166 | ||||||||
| FaxNumber: | 5855861370 | ||||||||
| Practice Location | |||||||||
| Address1: | 61 MONROE AVENUE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | PITTSFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855865166 | ||||||||
| FaxNumber: | 5855861370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 07/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | MUHLBAUER | ||||||||
| AuthorizedOfficialFirstName: | JAN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | LAB DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5855865166 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology |
ID Information
| ID | Type | State | Issuer | Description | CL017 | 01 | NY | PREFERRED CARE | OTHER | 00823996 | 05 | NY | MEDICAID | PO14939759 | 01 | NY | BLUE CHOICE | OTHER |