| Woodbridge Nurse Practitioner In Psychiatry Pllc | |
|
680 Davison Road Lockport NY 14094 | |
| (716) 940-8565 | |
| Not Available |
| Full Name | Woodbridge Nurse Practitioner In Psychiatry Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 680 Davison Road, Lockport, New York |
| Authorized Official Name and Position | Obot Obot (OWNER) |
| Authorized Official Contact | 7169408565 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Woodbridge Nurse Practitioner In Psychiatry Pllc 680 Davison Road Lockport NY 14094 Ph: (716) 940-8565 | Woodbridge Nurse Practitioner In Psychiatry Pllc 680 Davison Road Lockport NY 14094 Ph: (716) 940-8565 |
| NPI Number | 1780168732 |
|---|---|
| Provider Enumeration Date | 09/17/2018 |
| Last Update Date | 09/17/2018 |
| Medicare PECOS PAC ID | 5395086474 |
|---|---|
| Medicare Enrollment ID | O20190418001650 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780168732 | NPI | - | NPPES |
| 5179127 | Other | NY | NYS DEPT OF STATE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Obot A Obot |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861711467 PECOS PAC ID: 5698074953 Enrollment ID: I20160509001469 |
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