Healthcare Provider Details

I. General information

NPI: 1184910655
Provider Name (Legal Business Name): THE WELLNESS INSTITUTE OF GREATER BUFFALO AND WESTERN NEW YORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 NIAGARA SQ ROOM 607
BUFFALO NY
14202-3313
US

IV. Provider business mailing address

65 NIAGARA SQ ROOM 607
BUFFALO NY
14202-3313
US

V. Phone/Fax

Practice location:
  • Phone: 716-851-4052
  • Fax: 716-851-4309
Mailing address:
  • Phone: 716-851-4052
  • Fax: 716-851-4309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILIP L. HABERSTRO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 716-851-4052