Healthcare Provider Details

I. General information

NPI: 1932998788
Provider Name (Legal Business Name): GREG WHEELER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E GREEN ST
ITHACA NY
14850-5635
US

IV. Provider business mailing address

201 E GREEN ST
ITHACA NY
14850-5635
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-6200
  • Fax: 607-274-6200
Mailing address:
  • Phone: 607-274-6200
  • Fax: 607-274-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number123456789
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: