Healthcare Provider Details

I. General information

NPI: 1629847314
Provider Name (Legal Business Name): GREAT HEALTH MEDICAL AFIL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD STE R
SPRINGFIELD IL
62704-4188
US

IV. Provider business mailing address

407 WILLOUGHBY AVE
BROOKLYN NY
11205-4590
US

V. Phone/Fax

Practice location:
  • Phone: 212-201-1252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AHRON FELDMAN
Title or Position: OWNER
Credential:
Phone: 212-734-6621