Provider Demographics
NPI:1992486658
Name:WELL HEALTH MEDICAL PC
Entity type:Organization
Organization Name:WELL HEALTH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:WELL HEALTH MEDICAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-867-6681
Mailing Address - Street 1:820 2ND AVE RM 6A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4530
Mailing Address - Country:US
Mailing Address - Phone:212-867-6681
Mailing Address - Fax:347-332-1651
Practice Address - Street 1:820 2ND AVE RM 6A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4530
Practice Address - Country:US
Practice Address - Phone:212-867-6681
Practice Address - Fax:347-332-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty