Provider Demographics
NPI:1124658331
Name:WHITE OAK WELLNESS
Entity type:Organization
Organization Name:WHITE OAK WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:FULCINITI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-673-5653
Mailing Address - Street 1:1966 LINCOLN WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-2416
Mailing Address - Country:US
Mailing Address - Phone:412-673-5653
Mailing Address - Fax:412-673-5848
Practice Address - Street 1:1966 LINCOLN WAY STE 100
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-2416
Practice Address - Country:US
Practice Address - Phone:412-673-5653
Practice Address - Fax:412-673-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder