MEDICARE: WELLNESS IN INWOOD LLC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1740054113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS IN INWOOD LLC

Provider Business Mailing Address
First Line	:	148 POST AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-2667
Country	:	US
Telephone Number	:	845-267-1400
Fax Number	:	646-370-5420

Provider Business Practice Location Address
First Line	:	148 POST AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-2667
Country	:	US
Telephone Number	:	845-267-1400
Fax Number	:	646-370-5420

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MISS ELIZABETH URENA
Credential	:
Telephone Number	:	845-267-1400

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	10/24/2024

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