Provider Demographics
NPI:1386711612
Name:NEBRES, JOSE F (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:F
Last Name:NEBRES
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 1:15 FOX RUN
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5000
Mailing Address - Country:US
Mailing Address - Phone:518-281-3004
Mailing Address - Fax:518-272-3075
Practice Address - Street 1:15 FOX RUN
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110
Practice Address - Country:US
Practice Address - Phone:518-281-3004
Practice Address - Fax:518-272-3075
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00699972Medicaid
B82121Medicare UPIN
NY00699972Medicaid