Provider Demographics
NPI:1902862782
Name:ALBANESE, UMBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:UMBERTO
Middle Name:
Last Name:ALBANESE
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 1:6480 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5852
Mailing Address - Country:US
Mailing Address - Phone:716-631-3300
Mailing Address - Fax:716-631-3303
Practice Address - Street 1:6480 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5852
Practice Address - Country:US
Practice Address - Phone:716-631-3300
Practice Address - Fax:716-631-3303
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010001901OtherUNIVERA
NY005001411OtherCOMMUNITY BLUE
NY00784758Medicaid
NY0807584OtherINDEPENDENT HEALTH
NY0068584OtherGHI
NY005001411OtherCOMMUNITY BLUE
NY00784758Medicaid