Provider Demographics
NPI:1801380365
Name:WIDMER, HAYLEY
Entity Type:Individual
Prefix:MRS
First Name:HAYLEY
Middle Name:
Last Name:WIDMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 LEYDECKER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3704
Mailing Address - Country:US
Mailing Address - Phone:518-495-5083
Mailing Address - Fax:
Practice Address - Street 1:369 LEYDECKER RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3704
Practice Address - Country:US
Practice Address - Phone:518-495-5083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist