Provider Demographics
| NPI: | 1326092396 |
|---|---|
| Name: | HEARTSHAREWELLNESS LTD |
| Entity type: | Organization |
| Organization Name: | HEARTSHAREWELLNESS LTD |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CLINIC DIRECTOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JUDE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | ALEXANDRE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 718-855-7707 |
| Mailing Address - Street 1: | 177 LIVINGSTON STREET |
| Mailing Address - Street 2: | LOWER LEVEL |
| Mailing Address - City: | BROOKLYN |
| Mailing Address - State: | NY |
| Mailing Address - Zip Code: | 11201-4859 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 718-855-7707 |
| Mailing Address - Fax: | 718-855-7717 |
| Practice Address - Street 1: | 177 LIVINGSTON STREET |
| Practice Address - Street 2: | LOWER LEVEL |
| Practice Address - City: | BROOKLYN |
| Practice Address - State: | NY |
| Practice Address - Zip Code: | 11201-4859 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 718-855-7707 |
| Practice Address - Fax: | 718-855-7717 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-22 |
| Last Update Date: | 2015-08-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NY | 009398-3 | 103T00000X |
| NY | 014362-1 | 103T00000X |
| NY | 007089-1 | 103T00000X |
| NY | 011875-1 | 103TM1800X |
| NY | 163890-1 | 207R00000X |
| NY | 082372-1 | 2084P0800X |
| NY | 127961-1 | 2084P0800X |
| NY | 205290-1 | 2084P0800X |
| NY | N003927-1 | 213E00000X |
| NY | 012668-1 | 225100000X |
| NY | 016801-1 | 225100000X |
| NY | 010626-1 | 225X00000X |
| NY | 000959-1 | 231H00000X |
| NY | 000577-1 | 363A00000X |
| NY | F381397-1 | 363L00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NY | W39641 | Other | MEDICARE PTAN |
| NY | 02087016 | Medicaid | |
| NY | 02087016 | Medicaid |
