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General NPI Number Information
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NPI Number | 1770118333
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Entity Type | Organization
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Legal Business Name | 525 WHEAT LLC
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Dates
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Enumeration Date | 03/04/2020
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 525 WHEATFIELD ST
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-7034
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Country | US
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Telephone | 716-462-6353
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Fax |
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Provider Business Mailing Address
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Address Line | 525 WHEATFIELD ST
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-7034
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Country | US
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Telephone | 716-462-6353
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Fax |
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Authorized Official
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Title or Position | NUTRITION SPECIALIST
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Name | JOSEPH HANULA
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Credential | AASDN
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Telephone | 716-462-6353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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