Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Brockport Vine Medical PC

Organization Internal Medicine Physician · NPI 1871144543

Brockport Vine Medical PC is an Internal Medicine Physician in Brockport, New York. Registered with an NPI since 2019.

In the registry since
2019
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

122 W Ave Ste 6
Brockport, NY 14420-1225
Phone: (585) 208-8668
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X

Record details

NPI number1871144543
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Alex Fahoury — Owner · (585) 208-8668
NPI enumeratedSeptember 24, 2019
Last updated in NPPESJanuary 3, 2020
Certification dateJanuary 3, 2020
Mailing address67 Sarah Cir, Spencerport, NY 14559-9592

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