Provider Demographics
NPI:1790850949
Name:WHEELER, JAMES GIBSON JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GIBSON
Last Name:WHEELER
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 STILLWELL LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797
Mailing Address - Country:US
Mailing Address - Phone:516-692-4250
Mailing Address - Fax:516-692-4257
Practice Address - Street 1:35 STILLWELL LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797
Practice Address - Country:US
Practice Address - Phone:516-692-4250
Practice Address - Fax:516-692-4257
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3784103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY146950OtherVALUE OPTIONS
V61441Medicare ID - Type Unspecified