Healthcare Provider Details

I. General information

NPI: 1669306551
Provider Name (Legal Business Name): TRESTLE CARE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 3RD AVE STE 104
BRONX NY
10455-1057
US

IV. Provider business mailing address

1401 PENNSYLVANIA AVE STE 105A
WILMINGTON DE
19806-4125
US

V. Phone/Fax

Practice location:
  • Phone: 212-748-9208
  • Fax:
Mailing address:
  • Phone: 212-748-9208
  • Fax: 800-497-7434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WASEEM GHANNAM
Title or Position: MEMBER
Credential: MD
Phone: 212-748-9208