MEDICARE: ALBERT DEFABRITUS MD

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
1	207RN0300X	Nephrology Physician	120801	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629057583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT DEFABRITUS MD

Provider Business Mailing Address
First Line	:	352 7TH AVE
Second Line	:	SUITE 1003
City	:	NEW YORK
State	:	NY
Zip	:	10001-5012
Country	:	US
Telephone Number	:	212-807-8817
Fax Number	:	212-255-6577

Provider Business Practice Location Address
First Line	:	352 7TH AVE
Second Line	:	SUITE 1003
City	:	NEW YORK
State	:	NY
Zip	:	10001-5012
Country	:	US
Telephone Number	:	212-807-8817
Fax Number	:	212-255-6577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	09/02/2011

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