NPIMap

Organization Active NPI

Pain Treatment Medicine of the Finger Lakes PLLC

  • Interventional Pain Medicine Physician
  • Rochester, NY
National Provider Identifier
1477548360
Registry record updated Jan 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
PAIN TREATMENT MEDICINE OF THE FINGER LAKES PLLC
Practice address
30 Hagen Dr
Suite 230
Rochester, NY 14625-2658
Phone
(585) 899-3450
Fax
(585) 899-3454
NPI assigned
Sep 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donovan O Holder, MD
Title
Owner
Phone
(585) 899-3450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

30 Hagen Dr
Suite 230
Rochester, NY 14625-2658

Mailing address

PO Box 2005
East Syracuse, NY 13057-4505
Phone (315) 449-0513

Other identifiers 2

IdentifierTypeStateIssuer
02618835MedicaidNY
DC0842OtherRRMCR

National Provider Directory

National Provider Directory

Locations

30 Hagen Dr
Ste 230
Rochester, NY 14625
Phone (585) 381-0140

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201651200000",
    "number": "1477548360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2005",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130574505",
            "telephone_number": "315-449-0513",
            "fax_number": "315-445-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 HAGEN DR",
            "address_2": "SUITE 230",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146252658",
            "telephone_number": "585-899-3450",
            "fax_number": "585-899-3454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN TREATMENT MEDICINE OF THE FINGER LAKES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-16",
        "last_updated": "2008-01-30",
        "status": "A",
        "authorized_official_last_name": "HOLDER",
        "authorized_official_first_name": "DONOVAN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "585-899-3450",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02618835",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMCR",
            "identifier": "DC0842",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.