Active NPI
Philip R Lavine, MD
- Psychiatry Physician
- Rochester, NY
National Provider Identifier
1851463491
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 176177
- Practice address
- 211 C White Spruce Blvd
Rochester, NY 14623-1608 - Phone
- (585) 424-6460
- Fax
- (585) 424-5434
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 176177 | NY | Primary |
Addresses
Primary practice location
211 C White Spruce Blvd
Rochester, NY 14623-1608
Mailing address
211 C White Spruce Blvd
Rochester, NY 14623-1608
Phone (585) 424-6460
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11123213 | Other | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 176177 | NY | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851463491",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 C WHITE SPRUCE BLVD",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146231608",
"telephone_number": "585-424-6460",
"fax_number": "585-424-5434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 C WHITE SPRUCE BLVD",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146231608",
"telephone_number": "585-424-6460",
"fax_number": "585-424-5434"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAVINE",
"first_name": "PHILIP",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "176177",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11123213",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.