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General NPI Number Information
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NPI Number | 1376617480
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Entity Type | Organization
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Legal Business Name | WOMEN'S WELLNESS PLACE, PC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 739 IRVING AVE SUITE 300
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City | SYRACUSE
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State | NY
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Zip | 13210-1640
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Country | US
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Telephone | 315-478-1158
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Fax | 315-478-3014
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Provider Business Mailing Address
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Address Line | 739 IRVING AVE SUITE 300
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City | SYRACUSE
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State | NY
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Zip | 13210-1640
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Country | US
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Telephone | 315-478-1158
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Fax | 315-478-3014
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHANTELL DALPE-FUNG
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Credential | MD
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Telephone | 315-478-1158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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