Provider Demographics
NPI:1386725265
Name:WELLNESS MEDICAL HEALTHCARE, PC
Entity type:Organization
Organization Name:WELLNESS MEDICAL HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MORDECHAI
Authorized Official - Middle Name:FENIKEL
Authorized Official - Last Name:BAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-576-2828
Mailing Address - Street 1:110 LOCKWOOD AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5028
Mailing Address - Country:US
Mailing Address - Phone:914-576-2828
Mailing Address - Fax:914-576-4728
Practice Address - Street 1:110 LOCKWOOD AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5028
Practice Address - Country:US
Practice Address - Phone:914-576-2828
Practice Address - Fax:914-576-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195457174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWLW181Medicare ID - Type UnspecifiedGROUP PROVIDER ID