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General NPI Number Information
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NPI Number | 1679897953
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Entity Type | Organization
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Legal Business Name | PRISM HEALTH & FITNESS
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 6460 MAIN ST
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5838
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Country | US
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Telephone | 716-204-1477
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Fax | 716-204-1474
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Provider Business Mailing Address
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Address Line | 6460 MAIN ST
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5838
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Country | US
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Telephone | 716-204-1477
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Fax | 716-204-1474
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Authorized Official
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Title or Position | SITE DIRECTOR
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Name | MR. DAVID WILLARD
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Credential | BS
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Telephone | 716-204-1477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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