Healthcare Provider Details

I. General information

NPI: 1235224445
Provider Name (Legal Business Name): HARRY J WILBUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE VAMC
ALBANY NY
12208
US

IV. Provider business mailing address

PO BOX 31
GLENMONT NY
12077-0031
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-6597
  • Fax:
Mailing address:
  • Phone: 518-432-8050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number126848
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: