OrganizationActive
Medical Weight Loss of New York, PLLC
NPI 1174940696 · Obesity Medicine (Family Medicine) Physician · Fayetteville, NY
Provider details
- NPI number
- 1174940696
- Entity type
- Organization
- Primary specialty
- Obesity Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Bryan Wendel, Practice Manager(315) 445-0003
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
6800 E Genesee St
Suite 1501
Fayetteville, NY 13066-1089
Phone: (315) 391-9390
Fax: (315) 445-0056
Approximate (ZIP-level) locationGet directions
Mailing address
6800 E Genesee St
Fayetteville, NY 13066-1089
Registry dates
- Enumerated
- 2014-03-21
- Last updated
- 2014-03-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.