Provider Demographics
NPI:1588735203
Name:DIAZ-ORDAZ, ALBERT JOSE (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:JOSE
Last Name:DIAZ-ORDAZ
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 1:3065 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1239
Mailing Address - Country:US
Mailing Address - Phone:716-677-9220
Mailing Address - Fax:716-677-9226
Practice Address - Street 1:3065 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1239
Practice Address - Country:US
Practice Address - Phone:716-677-9220
Practice Address - Fax:716-677-9226
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162503174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC57918Medicare UPIN
NY11489BMedicare ID - Type Unspecified