Healthcare Provider Details

I. General information

NPI: 1952665754
Provider Name (Legal Business Name): PATRICIA J WILBER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LEO MOSS DR SUITE 4020
OLEAN NY
14760-1100
US

IV. Provider business mailing address

1 LEO MOSS DR SUITE 4020
OLEAN NY
14760-1100
US

V. Phone/Fax

Practice location:
  • Phone: 716-373-8050
  • Fax: 716-701-3737
Mailing address:
  • Phone: 716-373-8050
  • Fax: 716-701-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: