Provider Demographics
NPI:1942833835
Name:PRIMARY CARE METABOLIC DISORDERS MEDICAL PRACTICE, PLLC
Entity Type:Organization
Organization Name:PRIMARY CARE METABOLIC DISORDERS MEDICAL PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-624-9000
Mailing Address - Street 1:PO BOX 612
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-0612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2305 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6107
Practice Address - Country:US
Practice Address - Phone:315-624-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care