Brockport Vine Medical PC

NPI #1871144543 in Brockport, New York

Provider Information

NPI Number: 1871144543
Entity Type: Organization
Organization Name: Brockport Vine Medical PC
Primary Specialty: Internal Medicine
Enumeration Date: Sep 24, 2019
Last Updated: Jan 3, 2020

Practice Location

Address: 122 WEST AVE STE 6
City: Brockport
State: New York
ZIP Code: 14420-1225
Phone: (585) 208-8668

Authorized Official

Name: DR. ALEX FAHOURY, MD
Title: OWNER
Phone: (585) 208-8668

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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