Healthcare Provider Details

I. General information

NPI: 1790744043
Provider Name (Legal Business Name): WAYNE STEVEN STROUSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 KIMBALL AVE
PENN YAN NY
14527-1816
US

IV. Provider business mailing address

108 KIMBALL AVE
PENN YAN NY
14527-1816
US

V. Phone/Fax

Practice location:
  • Phone: 315-536-2273
  • Fax: 315-531-3056
Mailing address:
  • Phone: 315-536-2273
  • Fax: 315-531-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number199367
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: