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Organization
MEDICAL WEIGHT LOSS OF NEW YORK, PLLC
Active
Organization
MEDICAL WEIGHT LOSS OF NEW YORK, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN T WENDEL (PRACTICE MANAGER)
(315) 445-0003
Entity
Organization
Contact information
Practice address
6800 E GENESEE ST, SUITE 1501, FAYETTEVILLE, NY 13066-1089
(315) 391-9390
(315) 445-0056
Mailing address
6800 E GENESEE ST, SUITE 1501, FAYETTEVILLE, NY 13066-1089
(315) 391-9390
(315) 445-0056
Taxonomy
Speciality
Code
Description
License number
State
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
—
NULL
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
—
—
207RB0002X
Obesity Medicine (Internal Medicine) Physician
—
NULL
207RB0002X
Obesity Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
03/21/2014
Last updated
03/21/2014
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