MEDICARE: DAVID J WEGMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	310400000X	Assisted Living Facility	370F208	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316066566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID J WEGMAN

Provider Business Mailing Address
First Line	:	231 EAST AVE
Second Line	:
City	:	HILTON
State	:	NY
Zip	:	14468-1333
Country	:	US
Telephone Number	:	585-392-7171
Fax Number	:	585-392-3631

Provider Business Practice Location Address
First Line	:	231 EAST AVE
Second Line	:
City	:	HILTON
State	:	NY
Zip	:	14468-1333
Country	:	US
Telephone Number	:	585-392-7171
Fax Number	:	585-392-3631

Authorized Official
Title or Position	:	OUTSOURCED CONTROLLER
Name	:	OMAR S MOHAMED
Credential	:
Telephone Number	:	585-392-7171

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	12/14/2020

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Directions to “DAVID J WEGMAN ” Practice Location

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