Healthcare Provider Details

I. General information

NPI: 1699930206
Provider Name (Legal Business Name): WYOMING OB-GYN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S MAIN ST
WARSAW NY
14569
US

IV. Provider business mailing address

121 S MAIN ST
WARSAW NY
14569
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-8350
  • Fax: 585-786-8362
Mailing address:
  • Phone: 585-786-8350
  • Fax: 585-786-8362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2319771
License Number StateNY

VIII. Authorized Official

Name: SCOTT ALLAN TREUTUEIN
Title or Position: OWNER
Credential: MD
Phone: 585-786-8350