Provider Demographics
NPI:1447553987
Name:WILLIAM F DELUCA JR., M.D., P.C.
Entity type:Organization
Organization Name:WILLIAM F DELUCA JR., M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:518-724-2444
Mailing Address - Street 1:5 ULENSKI DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1103
Mailing Address - Country:US
Mailing Address - Phone:518-724-2444
Mailing Address - Fax:518-724-2445
Practice Address - Street 1:5 ULENSKI DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1103
Practice Address - Country:US
Practice Address - Phone:518-724-2444
Practice Address - Fax:518-724-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142157174400000X
208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00875392Medicaid
NY00875392Medicaid
NYD01950Medicare UPIN