Basic Information
| Provider Information | |||||||||
| NPI: | 1568552099 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED HEALTH & WELLNESS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2813 WEHRLE DR | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142217384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166306648 | ||||||||
| FaxNumber: | 7166306647 | ||||||||
| Practice Location | |||||||||
| Address1: | 2813 WEHRLE DR | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142217384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166306648 | ||||||||
| FaxNumber: | 7166306647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LAMARCA | ||||||||
| AuthorizedOfficialFirstName: | JODY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7166306648 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | R.D., CDN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 833179 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.