Provider Demographics
NPI:1154593028
Name:JUERSIVICH, ADAM PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:PAUL
Last Name:JUERSIVICH
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 1:601 ELMWOOD AVE BOX 278984
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 S. CLINTON AVE.
Practice Address - Street 2:BLDG F, SUITE 220
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2668
Practice Address - Country:US
Practice Address - Phone:585-341-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2671742084N0400X, 2084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME129922OtherSTATE LICENSE
NY03591022OtherMEDICAID (DSHS) NUMBER
NYJ400090702OtherMEDICARE NUMBER