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General NPI Number Information
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NPI Number | 1447624507
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Entity Type | Organization
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Legal Business Name | GUIDLING LIGHT HEALTH LLC
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 1315 S ALLEN ST SUITE 104, 2ND FLOOR
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City | STATE COLLEGE
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State | PA
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Zip | 16801-5923
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Country | US
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Telephone | 814-753-4422
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 S ALLEN ST STE 104
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City | STATE COLLEGE
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State | PA
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Zip | 16801-5923
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Country | US
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Telephone | 814-753-4422
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DMITRY A VILENSKY
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Credential | MD
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Telephone | 814-753-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD451033
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License Number State | PA
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