Provider Demographics
NPI:1407002371
Name:CENTER FOR ADOLESCENT & YOUNG ADULT HEALTH
Entity Type:Organization
Organization Name:CENTER FOR ADOLESCENT & YOUNG ADULT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-225-2600
Mailing Address - Street 1:1081 LONG POND RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-5002
Mailing Address - Country:US
Mailing Address - Phone:585-225-2600
Mailing Address - Fax:585-225-2606
Practice Address - Street 1:1081 LONG POND RD
Practice Address - Street 2:SUITE 240
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5002
Practice Address - Country:US
Practice Address - Phone:585-225-2600
Practice Address - Fax:585-225-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY484831041C0700X
NY222620207RA0000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty