Healthcare Provider Details

I. General information

NPI: 1407002371
Provider Name (Legal Business Name): CENTER FOR ADOLESCENT & YOUNG ADULT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 LONG POND RD SUITE 240
ROCHESTER NY
14626-5002
US

IV. Provider business mailing address

1081 LONG POND RD SUITE 240
ROCHESTER NY
14626-5002
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-2600
  • Fax: 585-225-2606
Mailing address:
  • Phone: 585-225-2600
  • Fax: 585-225-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number222620
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number48483
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number222620
License Number StateNY

VIII. Authorized Official

Name: DR. JEFFREY D ALBERTS
Title or Position: DOCTOR
Credential: MD
Phone: 585-225-2600