Healthcare Provider Details

I. General information

NPI: 1245259027
Provider Name (Legal Business Name): JAY WILLNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N WILKES BARRE BLVD STE 103
WILKES BARRE PA
18702-5240
US

IV. Provider business mailing address

7 OLD ORCHARD LN
MOUNTAIN TOP PA
18707-1742
US

V. Phone/Fax

Practice location:
  • Phone: 570-846-2720
  • Fax: 570-706-9629
Mailing address:
  • Phone: 570-881-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD040729E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD040729E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: