Provider Demographics
NPI:1629057583
Name:DEFABRITUS, ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:DEFABRITUS
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 1:352 7TH AVE
Mailing Address - Street 2:SUITE 1003
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5012
Mailing Address - Country:US
Mailing Address - Phone:212-807-8817
Mailing Address - Fax:212-255-6577
Practice Address - Street 1:352 7TH AVE
Practice Address - Street 2:SUITE 1003
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5012
Practice Address - Country:US
Practice Address - Phone:212-807-8817
Practice Address - Fax:212-255-6577
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120801207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00344472Medicaid
NYB13404Medicare UPIN
NY00344472Medicaid