Provider Demographics
NPI:1962510792
Name:MONTESANO, WILLIAM J JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:MONTESANO
Suffix:JR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1401 STONE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-1537
Mailing Address - Country:US
Mailing Address - Phone:585-865-1110
Mailing Address - Fax:585-865-1124
Practice Address - Street 1:1401 STONE RD
Practice Address - Street 2:STE 201
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-1537
Practice Address - Country:US
Practice Address - Phone:585-865-1110
Practice Address - Fax:585-865-1124
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-12-16
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Provider Licenses
StateLicense IDTaxonomies
NY233057-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02600993Medicaid
NY02600993Medicaid