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NPI Code Detail

MEDICARE: WELLLIFE NETWORK INC.

MEDICARE: WELLLIFE NETWORK INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386817906
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLLIFE NETWORK INC.
Provider Business Mailing Address
First Line : 1985 MARCUS AVE STE 100
Second Line :
City : NEW HYDE PARK
State : NY
Zip : 11042-2025
Country : US
Telephone Number : 718-559-0516
Fax Number : 718-762-6140
Provider Business Practice Location Address
First Line : 3600 ROUTE 112
Second Line :
City : CORAM
State : NY
Zip : 11727-4116
Country : US
Telephone Number : 631-920-8302
Fax Number : 631-920-8462
Authorized Official
Title or Position : CEO
Name : SHERRY TUCKER
Credential :
Telephone Number : 718-559-0534
Provider Enumeration Date : 04/03/2008
Last Update Date : 08/16/2024

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Directions to “WELLLIFE NETWORK INC. ” Practice Location

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