Provider Demographics
NPI:1194995670
Name:WHOLESOME MEDICAL PC
Entity type:Organization
Organization Name:WHOLESOME MEDICAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLESSEY
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-352-1804
Mailing Address - Street 1:1575 HILLSIDE AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2521
Mailing Address - Country:US
Mailing Address - Phone:516-352-1804
Mailing Address - Fax:516-352-1449
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:STE 103
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2521
Practice Address - Country:US
Practice Address - Phone:516-352-1804
Practice Address - Fax:516-352-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272156207R00000X
NY185251207RC0000X
NY164546207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty