Provider Demographics
NPI:1760651061
Name:BRIGHTON CONSULTING FOR OCCUPATIONAL & ENVIRONMENTAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:BRIGHTON CONSULTING FOR OCCUPATIONAL & ENVIRONMENTAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TEDANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:WIBBERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-271-2390
Mailing Address - Street 1:PO BOX 10532
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-0532
Mailing Address - Country:US
Mailing Address - Phone:585-271-2390
Mailing Address - Fax:585-271-2877
Practice Address - Street 1:233 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2518
Practice Address - Country:US
Practice Address - Phone:585-271-2390
Practice Address - Fax:585-271-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149426174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA0531Medicare PIN