Provider Demographics
NPI:1497260442
Name:JEFFREY WHEELER DO PC
Entity Type:Organization
Organization Name:JEFFREY WHEELER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-805-6384
Mailing Address - Street 1:65 BENNETT PL
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3601
Mailing Address - Country:US
Mailing Address - Phone:631-805-6384
Mailing Address - Fax:631-849-5824
Practice Address - Street 1:65 BENNETT PL
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3601
Practice Address - Country:US
Practice Address - Phone:631-805-6384
Practice Address - Fax:631-849-5824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213785-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty