Provider Demographics
NPI:1063731412
Name:WILBUR, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WILBUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2197 MT HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-7313
Mailing Address - Country:US
Mailing Address - Phone:845-386-9483
Mailing Address - Fax:845-386-9483
Practice Address - Street 1:2197 MT HOPE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-7313
Practice Address - Country:US
Practice Address - Phone:845-386-9483
Practice Address - Fax:845-386-9483
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402036-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health