Provider Demographics
NPI:1073515839
Name:KRESGE, JAMES A (RPAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:KRESGE
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N UNION ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1345
Mailing Address - Country:US
Mailing Address - Phone:585-232-8940
Mailing Address - Fax:585-232-8687
Practice Address - Street 1:30 N UNION ST
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1345
Practice Address - Country:US
Practice Address - Phone:585-232-8940
Practice Address - Fax:585-232-8687
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0010961363A00000X
NY001096-1207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP46929Medicare UPIN
NYPA0519Medicare ID - Type UnspecifiedMEDICARE NUMBER