Provider Demographics
NPI:1518161496
Name:IMOBERSTEG, ALBERT MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:MICHAEL
Last Name:IMOBERSTEG
Suffix:
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 1:206 CORNELIA ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2779
Mailing Address - Country:US
Mailing Address - Phone:518-561-5516
Mailing Address - Fax:518-563-7421
Practice Address - Street 1:206 CORNELIA ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2779
Practice Address - Country:US
Practice Address - Phone:518-561-5516
Practice Address - Fax:518-563-7421
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0011211207X00000X
NY168571207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B82980Medicare UPIN