Individual
MR. JENS L. WENNBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
501 MIDLINE RD, FREEVILLE, NY 13068-5625
(607) 539-7733
Mailing address
501 MIDLINE RD, FREEVILLE, NY 13068-5625
(607) 539-7733
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004990
NY
Other
Enumeration date
12/18/2008
Last updated
09/07/2010
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