Provider Demographics
NPI:1396524732
Name:MED WELLNESS CARE LLC
Entity type:Organization
Organization Name:MED WELLNESS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-796-9000
Mailing Address - Street 1:168 BEDELL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-2057
Mailing Address - Country:US
Mailing Address - Phone:917-613-1585
Mailing Address - Fax:
Practice Address - Street 1:1800 S OCEAN DR APT 1003
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-7722
Practice Address - Country:US
Practice Address - Phone:917-613-1585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health