Provider Demographics
NPI:1386091932
Name:DWELL MEDICAL GROUP PC
Entity type:Organization
Organization Name:DWELL MEDICAL GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:A.
Authorized Official - Middle Name:BARTLEY
Authorized Official - Last Name:BYRT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-558-7858
Mailing Address - Street 1:2710 LONG BEACH RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2255
Mailing Address - Country:US
Mailing Address - Phone:516-558-7858
Mailing Address - Fax:516-812-3975
Practice Address - Street 1:2710 LONG BEACH RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2255
Practice Address - Country:US
Practice Address - Phone:516-558-7858
Practice Address - Fax:516-812-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185275208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty