Provider Demographics
NPI:1003602251
Name:FUNK, WADE THOMAS
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:THOMAS
Last Name:FUNK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 FEUZ RD
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306-5835
Mailing Address - Country:US
Mailing Address - Phone:518-728-2523
Mailing Address - Fax:
Practice Address - Street 1:285 FEUZ RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-5835
Practice Address - Country:US
Practice Address - Phone:518-728-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program