Healthcare Provider Details

I. General information

NPI: 1285643155
Provider Name (Legal Business Name): JEFFREY CHARLES STROMBERG CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1322 WEST STATE STREET
OLEAN NY
14760
US

IV. Provider business mailing address

1322 WEST STATE STREET
OLEAN NY
14760
US

V. Phone/Fax

Practice location:
  • Phone: 716-372-7761
  • Fax:
Mailing address:
  • Phone: 716-372-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: