Provider Demographics
NPI:1235104183
Name:DELUCA, WILLIAM F JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:DELUCA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ULENSKI DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1103
Mailing Address - Country:US
Mailing Address - Phone:518-724-2444
Mailing Address - Fax:518-724-2445
Practice Address - Street 1:5 ULENSKI DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1103
Practice Address - Country:US
Practice Address - Phone:518-724-2444
Practice Address - Fax:518-724-2445
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY142157-01208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00875392Medicaid
NY33395JMedicare ID - Type Unspecified
NYD01950Medicare UPIN