MEDICARE: WELLNEXX, 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
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1538835574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNEXX, INC.

Provider Business Mailing Address
First Line	:	4 MEADOWOOD CT
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-3829
Country	:	US
Telephone Number	:	631-214-6024
Fax Number	:

Provider Business Practice Location Address
First Line	:	1930 VETERANS HIGHWAY SUITE 15
Second Line	:	ISLANDIA, NY 11749
City	:	HUNTINGTON
State	:	NY
Zip	:	11743
Country	:	US
Telephone Number	:	631-214-6024
Fax Number	:

Authorized Official
Title or Position	:	CEO AND CLINICAL DIRECTOR
Name	:	DR. JAMES WILLIAM WYCKOFF
Credential	:	DHA, LMT
Telephone Number	:	631-214-6024

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	08/19/2021

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