Provider Demographics
NPI:1578726428
Name:DEBADTS, ROBERT ABRAM JR (RPAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ABRAM
Last Name:DEBADTS
Suffix:JR
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 1:1425 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-0400
Mailing Address - Fax:585-922-0455
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-0400
Practice Address - Fax:585-922-0455
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03033832Medicaid
PA2662Medicare PIN
J400077226Medicare PIN
70005AMedicare PIN