Provider Demographics
NPI:1518016997
Name:CHITTENANGO MEDICAL & WELLNESS ASSOC PC
Entity Type:Organization
Organization Name:CHITTENANGO MEDICAL & WELLNESS ASSOC PC
Other - Org Name:LAFAYETTE HEALTHCARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRESOHLAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-687-6467
Mailing Address - Street 1:304 GENESEE STREET
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-1707
Mailing Address - Country:US
Mailing Address - Phone:315-687-6467
Mailing Address - Fax:315-251-2240
Practice Address - Street 1:304 GENESEE STREET
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-1707
Practice Address - Country:US
Practice Address - Phone:315-687-6467
Practice Address - Fax:315-251-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty