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General NPI Number Information
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NPI Number | 1659701902
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Entity Type | Organization
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Legal Business Name | PEARLS OF WISDOMOTB LLC
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Dates
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Enumeration Date | 11/23/2013
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Last Update Date | 11/23/2013
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Provider Practice Location Address
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Address Line | 76 ORANGE ST
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City | BUFFALO
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State | NY
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Zip | 14204-1219
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Country | US
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Telephone | 716-856-0360
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Fax |
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Provider Business Mailing Address
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Address Line | 76 ORANGE ST
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City | BUFFALO
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State | NY
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Zip | 14204-1219
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Country | US
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Telephone | 716-856-0360
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. CYNTHIA ANN FELDER
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Credential | RN
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Telephone | 716-573-4290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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