Provider Demographics
NPI:1104987064
Name:URRESTA, FABIO LEONIDAS (MD, MS)
Entity type:Individual
Prefix:DR
First Name:FABIO
Middle Name:LEONIDAS
Last Name:URRESTA
Suffix:
Gender:M
Credentials:MD, MS
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Mailing Address - Street 1:3 NEWCASTLE RD
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6123
Mailing Address - Country:US
Mailing Address - Phone:518-724-5151
Mailing Address - Fax:518-207-9078
Practice Address - Street 1:3 NEWCASTLE RD
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-6123
Practice Address - Country:US
Practice Address - Phone:518-724-5151
Practice Address - Fax:518-207-9078
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2471632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
05446216OtherECFMG
NY6022352OtherMVP
NY0046572OtherEMPIRE BLUE CROSS BLUE SHIELD
NY1891946323OtherMEDICARE GROUP
NY533029OtherCIGNA BEHAVIORAL HEALTH
NY605560OtherVALUE OPTIONS
NY000417902002OtherBLUE SHIELD OF NORTHEASTERN NEW YORKI
NY1104987064OtherMEDICARE INDIVIDUAL