Healthcare Provider Details

I. General information

NPI: 1053994889
Provider Name (Legal Business Name): WELL-BEING PEDIATRICS & ADOLESCENT MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 3RD ST
ITHACA NY
14850-3484
US

IV. Provider business mailing address

402 3RD ST
ITHACA NY
14850-3484
US

V. Phone/Fax

Practice location:
  • Phone: 607-602-2083
  • Fax: 607-208-7244
Mailing address:
  • Phone: 607-602-2083
  • Fax: 607-208-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA CASEY
Title or Position: OWNER
Credential: DO
Phone: 607-602-2083