Healthcare Provider Details

I. General information

NPI: 1346331402
Provider Name (Legal Business Name): JAMES WHALEN L'EPISCOPO P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PARK ST
ELIZABETHTOWN NY
12932
US

IV. Provider business mailing address

46 WATER ST. P.O. BOX 834
ELIZABETHTOWN NY
12932-0834
US

V. Phone/Fax

Practice location:
  • Phone: 518-873-6377
  • Fax: 518-873-2091
Mailing address:
  • Phone: 518-873-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003281-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: