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General NPI Number Information
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NPI Number | 1316066566
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Entity Type | Organization
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Legal Business Name | DAVID J WEGMAN
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 231 EAST AVE
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City | HILTON
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State | NY
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Zip | 14468-1333
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Country | US
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Telephone | 585-392-7171
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Fax | 585-392-3631
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Provider Business Mailing Address
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Address Line | 231 EAST AVE
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City | HILTON
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State | NY
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Zip | 14468-1333
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Country | US
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Telephone | 585-392-7171
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Fax | 585-392-3631
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Authorized Official
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Title or Position | OUTSOURCED CONTROLLER
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Name | OMAR S MOHAMED
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Credential |
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Telephone | 585-392-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 370F208
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License Number State | NY
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