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NPI Code Detail

MEDICARE: CHITTENANGO MEDICAL & WELLNESS ASSOC PC

MEDICARE: CHITTENANGO MEDICAL & WELLNESS ASSOC PC
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
1207QA0505XAdult Medicine Physician
2207RG0300XGeriatric Medicine (Internal Medicine) Physician
3207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1518016997
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHITTENANGO MEDICAL & WELLNESS ASSOC PC
Provider Business Mailing Address
First Line : 304 GENESEE STREET
Second Line :
City : CHITTENANGO
State : NY
Zip : 13037-1707
Country : US
Telephone Number : 315-687-6467
Fax Number : 315-251-2240
Provider Business Practice Location Address
First Line : 304 GENESEE STREET
Second Line :
City : CHITTENANGO
State : NY
Zip : 13037-1707
Country : US
Telephone Number : 315-687-6467
Fax Number : 315-251-2240
Authorized Official
Title or Position : OFFICE MANAGER/BILLING MANAGER
Name : BRIANNE L TRESOHLAVY
Credential :
Telephone Number : 315-687-6467
Provider Enumeration Date : 01/09/2007
Last Update Date : 01/29/2019

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Directions to “CHITTENANGO MEDICAL & WELLNESS ASSOC PC ” Practice Location

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