Provider Demographics
NPI:1053994889
Name:WELL-BEING PEDIATRICS & ADOLESCENT MEDICINE, PLLC
Entity type:Organization
Organization Name:WELL-BEING PEDIATRICS & ADOLESCENT MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:607-602-2083
Mailing Address - Street 1:402 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3484
Mailing Address - Country:US
Mailing Address - Phone:607-602-2083
Mailing Address - Fax:607-208-7244
Practice Address - Street 1:402 3RD ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3484
Practice Address - Country:US
Practice Address - Phone:607-602-2083
Practice Address - Fax:607-208-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02272517Medicaid