Provider Demographics
NPI:1861865958
Name:WILKINS, GREGORY RICHARD (LAC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:RICHARD
Last Name:WILKINS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2709
Mailing Address - Country:US
Mailing Address - Phone:607-288-2055
Mailing Address - Fax:
Practice Address - Street 1:66 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2709
Practice Address - Country:US
Practice Address - Phone:607-288-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005602171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist