Provider Demographics
NPI:1609236082
Name:WILCZEK, JESSICA (DPM)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:WILCZEK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ROTARY AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4181
Mailing Address - Country:US
Mailing Address - Phone:315-368-4206
Mailing Address - Fax:
Practice Address - Street 1:10 ROTARY AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4181
Practice Address - Country:US
Practice Address - Phone:315-368-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP97785213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery