MEDICARE: WELLNESS NEUROLOGY 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
1	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1982325692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS NEUROLOGY PC

Provider Business Mailing Address
First Line	:	108 W 39TH ST RM 405
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-3649
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 W 39TH ST RM 405
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-3649
Country	:	US
Telephone Number	:	646-559-4659
Fax Number	:	917-633-4365

Authorized Official
Title or Position	:	OWNER
Name	:	AUDREY HALPERN
Credential	:	MD
Telephone Number	:	646-559-4659

Provider Enumeration Date	:	09/09/2022
Last Update Date	:	09/12/2022

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Directions to “WELLNESS NEUROLOGY PC ” Practice Location

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