Healthcare Provider Details

I. General information

NPI: 1124658331
Provider Name (Legal Business Name): WHITE OAK WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1966 LINCOLN WAY STE 100
WHITE OAK PA
15131-2416
US

IV. Provider business mailing address

1966 LINCOLN WAY STE 100
WHITE OAK PA
15131-2416
US

V. Phone/Fax

Practice location:
  • Phone: 412-673-5653
  • Fax: 412-673-5848
Mailing address:
  • Phone: 412-673-5653
  • Fax: 412-673-5848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROCCO ANTON FULCINITI
Title or Position: PHYSICIAN
Credential: MD
Phone: 412-673-5653