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General NPI Number Information
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NPI Number | 1609541051
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Entity Type | Organization
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Legal Business Name | THEPHWC LLP
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 1942 MILITARY TPKE
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City | PLATTSBURGH
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State | NY
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Zip | 12901-7375
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Country | US
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Telephone | 518-310-3644
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Fax | 518-310-3645
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Provider Business Mailing Address
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Address Line | 334 CORNELIA ST
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City | PLATTSBURGH
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State | NY
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Zip | 12901-2329
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Country | US
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Telephone | 518-578-4749
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KELSEY JUNTUNEN
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Credential |
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Telephone | 518-578-4749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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