Provider Demographics
NPI:1588732333
Name:WANCK, WILLIAM BICK N (M D)
Entity type:Individual
Prefix:
First Name:WILLIAM BICK
Middle Name:N
Last Name:WANCK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:BICK
Other - Middle Name:N
Other - Last Name:WANCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:401 GEYSER ROAD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866
Mailing Address - Country:US
Mailing Address - Phone:518-583-3035
Mailing Address - Fax:518-583-4247
Practice Address - Street 1:401 GEYSER ROAD
Practice Address - Street 2:
Practice Address - City:SARASOTA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-583-3035
Practice Address - Fax:518-583-4247
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1472602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E16894Medicare UPIN
NY53286BMedicare ID - Type Unspecified