Provider Demographics
NPI:1477869816
Name:STEPHEN E PRESSER M.D. PC
Entity Type:Organization
Organization Name:STEPHEN E PRESSER M.D. PC
Other - Org Name:ADVANCED DERMATOLOGY ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERVISING PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:PRESSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-442-4310
Mailing Address - Street 1:1815 SOUTH CLINTON AVENUE
Mailing Address - Street 2:STE 530
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-442-4310
Mailing Address - Fax:585-442-6750
Practice Address - Street 1:1815 SOUTH CLINTON AVENUE
Practice Address - Street 2:STE 530
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-442-4310
Practice Address - Fax:585-442-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149206-1207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B75572Medicare UPIN
10602AMedicare UPIN