Provider Demographics
NPI:1306177365
Name:WELLCORE MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:WELLCORE MEDICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SALIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-356-5412
Mailing Address - Street 1:PO BOX 29219
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-9219
Mailing Address - Country:US
Mailing Address - Phone:631-356-5412
Mailing Address - Fax:631-918-7119
Practice Address - Street 1:34 LINDBERGH CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-5367
Practice Address - Country:US
Practice Address - Phone:631-356-5412
Practice Address - Fax:631-918-7119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194072207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA10847Medicare UPIN