| Michael Dejesus, MD | |
|
7980 State Route 12, Barneveld, NY 13304-2536 | |
| (315) 624-8440 | |
| (315) 624-5113 |
| Full Name | Michael Dejesus |
|---|---|
| Gender | Male |
| Speciality | Family Medicine |
| Location | 7980 State Route 12, Barneveld, New York |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528161338 | NPI | - | NPPES |
| 137801 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 137801 (New York) | Primary |
| Entity Name | Upstate Cerebral Palsy Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780636506 PECOS PAC ID: 5496734758 Enrollment ID: O20040719001380 |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Dejesus, MD 5596 Military Rd, Remsen, NY 13438-6008 Ph: Not Available | Michael Dejesus, MD 7980 State Route 12, Barneveld, NY 13304-2536 Ph: (315) 624-8440 |
Gyasi Kodua, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 7980 State Route 12, Barneveld, NY 13304 Phone: 315-624-8440 Fax: 315-624-8842 |
Dr. Michael Joseph Attilio, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 7980 State Route 12, Barneveld, NY 13304 Phone: 315-624-8440 |
Dr. Bruce R Elwell, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 7980 State Route 12, Barneveld, NY 13304 Phone: 315-624-8440 Fax: 315-624-8450 |