Healthcare Provider Details

I. General information

NPI: 1821299587
Provider Name (Legal Business Name): ALAN J. WABREK M.D., DR.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 FRONT ST
BINGHAMTON NY
13905-2424
US

IV. Provider business mailing address

225 FRONT ST
BINGHAMTON NY
13905-2424
US

V. Phone/Fax

Practice location:
  • Phone: 607-778-2802
  • Fax: 607-778-2838
Mailing address:
  • Phone: 607-778-3917
  • Fax: 607-778-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number111966-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: