Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD040729E | PA |
N | 207V00000X | Obstetrician & Gynecologist | MD-040729-E | NY |
NPI | 1245259027 |
---|---|
Provider Name | Dr. Jay Willner |
First Address | Wilkes-Barre, PA 18702 |
Second Address | Mountain Top, PA 18707-1742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 03/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A65003 | (02) | PA |