Provider Demographics
NPI:1164525259
Name:HILTON EAST ASSISTED LIVING
Entity Type:Organization
Organization Name:HILTON EAST ASSISTED LIVING
Other - Org Name:DAVID J. WEGMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:585-392-7171
Mailing Address - Street 1:231 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1333
Mailing Address - Country:US
Mailing Address - Phone:585-392-7171
Mailing Address - Fax:585-392-1112
Practice Address - Street 1:231 EAST AVE
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1333
Practice Address - Country:US
Practice Address - Phone:585-392-7171
Practice Address - Fax:585-392-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01614539Medicaid