Provider Demographics
NPI:1972733400
Name:STREB, ADAM J (PA)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:J
Last Name:STREB
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4209
Mailing Address - Country:US
Mailing Address - Phone:585-225-5050
Mailing Address - Fax:585-720-0776
Practice Address - Street 1:2664 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4209
Practice Address - Country:US
Practice Address - Phone:585-225-5050
Practice Address - Fax:585-720-0776
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013353363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant