Provider Demographics
NPI:1154395648
Name:VENTRESCA, EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:VENTRESCA
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:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14303-0111
Mailing Address - Country:US
Mailing Address - Phone:716-298-8133
Mailing Address - Fax:716-298-8136
Practice Address - Street 1:6941 ELAINE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2877
Practice Address - Country:US
Practice Address - Phone:716-298-8133
Practice Address - Fax:716-298-8136
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191202207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01419974Medicaid
NYCC8645Medicare ID - Type UnspecifiedMEDICARE NUMBER
NY01419974Medicaid