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NPI Code Detail

MEDICARE: ASSOCIATED MEDICAL PROFESSIONALS OF NY, PLLC

MEDICARE: ASSOCIATED MEDICAL PROFESSIONALS OF NY, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician

General Provider Information

NPI Number : 1407197486
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASSOCIATED MEDICAL PROFESSIONALS OF NY, PLLC
Provider Business Mailing Address
First Line : 100 METROPOLITAN PARK DR STE 100
Second Line :
City : LIVERPOOL
State : NY
Zip : 13088-5842
Country : US
Telephone Number : 315-870-9370
Fax Number : 315-870-9364
Provider Business Practice Location Address
First Line : 192 GENESEE ST
Second Line :
City : AUBURN
State : NY
Zip : 13021-3361
Country : US
Telephone Number : 315-258-5253
Fax Number : 315-258-0202
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : DR. ANGELO R. DEROSALIA
Credential : MD
Telephone Number : 315-458-3343
Provider Enumeration Date : 03/15/2013
Last Update Date : 07/15/2020

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