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General NPI Number Information
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NPI Number | 1790718583
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Entity Type | Organization
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Legal Business Name | CREDI & DESA ASSOCIATES P.C.
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 403 GARDEN DR
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City | BATAVIA
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State | NY
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Zip | 14020-1717
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Country | US
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Telephone | 585-343-4632
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Fax | 585-343-8017
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Provider Business Mailing Address
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Address Line | 403 GARDEN DR
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City | BATAVIA
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State | NY
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Zip | 14020-1717
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Country | US
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Telephone | 585-343-4632
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Fax | 585-343-8017
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAGDI E. CREDI
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Credential | M.D.
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Telephone | 585-343-4632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 123054
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License Number State | NY
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