Provider Demographics
NPI:1184910655
Name:THE WELLNESS INSTITUTE OF GREATER BUFFALO AND WESTERN NEW YORK, INC.
Entity type:Organization
Organization Name:THE WELLNESS INSTITUTE OF GREATER BUFFALO AND WESTERN NEW YORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:HABERSTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-851-4052
Mailing Address - Street 1:65 NIAGARA SQ
Mailing Address - Street 2:ROOM 607
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-3313
Mailing Address - Country:US
Mailing Address - Phone:716-851-4052
Mailing Address - Fax:716-851-4309
Practice Address - Street 1:65 NIAGARA SQ
Practice Address - Street 2:ROOM 607
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3313
Practice Address - Country:US
Practice Address - Phone:716-851-4052
Practice Address - Fax:716-851-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty