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NPI Code Detail

MEDICARE: THE WELLNESS CARE NP IN FAMILY HEALTH PC

MEDICARE: THE WELLNESS CARE NP IN FAMILY HEALTH PC
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
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1518744879
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE WELLNESS CARE NP IN FAMILY HEALTH PC
Provider Business Mailing Address
First Line : 701 W 177TH ST APT 43
Second Line :
City : NEW YORK
State : NY
Zip : 10033-6909
Country : US
Telephone Number : 347-426-7513
Fax Number :
Provider Business Practice Location Address
First Line : 31 E 32ND ST RM 610
Second Line :
City : NEW YORK
State : NY
Zip : 10016-5592
Country : US
Telephone Number : 347-426-7513
Fax Number :
Authorized Official
Title or Position : NURSE PRACTITIONER
Name : KAB JU KIM-AMARO
Credential : NP
Telephone Number : 347-426-7513
Provider Enumeration Date : 09/11/2023
Last Update Date : 06/04/2024

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