Provider Demographics
NPI:1104899335
Name:ALBERTS, JEFFREY D (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:ALBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 LONG POND RD STE 240
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-5002
Mailing Address - Country:US
Mailing Address - Phone:585-225-2600
Mailing Address - Fax:585-225-2606
Practice Address - Street 1:1081 LONG POND RD STE 240
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5002
Practice Address - Country:US
Practice Address - Phone:585-225-2600
Practice Address - Fax:585-225-2606
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222620174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02357606Medicaid
NYR83081Medicare UPIN