Healthcare Provider Details

I. General information

NPI: 1205027935
Provider Name (Legal Business Name): ERIC C WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 07/17/2023
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 LIBERTY ST STE 3
BATAVIA NY
14020-3253
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 888
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-0933
  • Fax:
Mailing address:
  • Phone: 585-344-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number256291
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number256291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: