MEDICARE: PEARLS OF WISDOMOTB LLC

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1659701902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARLS OF WISDOMOTB LLC

Provider Business Mailing Address
First Line	:	76 ORANGE ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14204-1219
Country	:	US
Telephone Number	:	716-856-0360
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 ORANGE ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14204-1219
Country	:	US
Telephone Number	:	716-856-0360
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MS. CYNTHIA ANN FELDER
Credential	:	RN
Telephone Number	:	716-573-4290

Provider Enumeration Date	:	11/23/2013
Last Update Date	:	11/23/2013

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