Healthcare Provider Details

I. General information

NPI: 1265794457
Provider Name (Legal Business Name): VILMA JUNIO PHYSICIAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W UTICA ST SUITE B
OSWEGO NY
13126-3165
US

IV. Provider business mailing address

101 W UTICA ST SUITE B
OSWEGO NY
13126-3165
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-4217
  • Fax: 877-798-8125
Mailing address:
  • Phone: 315-342-4217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number233306
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number525939
License Number StateNY

VIII. Authorized Official

Name: DR. VILMA JUNIO
Title or Position: PHYSICIAN/PRESIDENT
Credential: MD
Phone: 315-342-4217