Provider Demographics
NPI:1053869263
Name:MATTESON-BUDDE, JOSHUA KENNETH
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KENNETH
Last Name:MATTESON-BUDDE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3327 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-9746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3327 BROWN RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-9746
Practice Address - Country:US
Practice Address - Phone:585-590-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5925583747P1801X
NY447573146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant