Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Glenn H Fredenburg

Individual provider Family Nurse Practitioner · NPI 1679152664

Glenn H Fredenburg is a Nurse Practitioner in Buffalo, New York. Qualified in 2021, 5 years ago. Practices with Adirondack Medical Practice LLC, a 6-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Vermont.

Years since qualifying
5
Licensed in
VT
In the registry since
2021
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Practice location Address checks out

40 La Riviere Dr Ste 201
Buffalo, NY 14202-4344
Phone: (518) 335-5097
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 101.0134798 (VT)

Record details

NPI number1679152664
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedApril 6, 2021
Last updated in NPPESApril 27, 2022
Certification dateApril 27, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Adirondack Medical Practice Llc — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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