Provider Demographics
NPI:1609804368
Name:ADDESA, ALBERT J JR (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:J
Last Name:ADDESA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1616 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1433
Mailing Address - Country:US
Mailing Address - Phone:716-835-3097
Mailing Address - Fax:716-837-4654
Practice Address - Street 1:5532 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-2224
Practice Address - Country:US
Practice Address - Phone:716-683-5252
Practice Address - Fax:716-683-6885
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY144992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00725315Medicaid
NYB71711Medicare UPIN
NYH26307Medicare ID - Type Unspecified