Healthcare Provider Details

I. General information

NPI: 1073633574
Provider Name (Legal Business Name): MEDWELL WOMENS MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2183 OCEAN AVE
BROOKLYN NY
11229-2303
US

IV. Provider business mailing address

2183 OCEAN AVE
BROOKLYN NY
11229-2303
US

V. Phone/Fax

Practice location:
  • Phone: 718-382-6565
  • Fax: 718-382-6658
Mailing address:
  • Phone: 718-382-6565
  • Fax: 718-382-6658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF000809
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number115489
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number221715
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF001207
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number221182
License Number StateNY

VIII. Authorized Official

Name: DR. NORMA PEREZ VERIDIANO
Title or Position: OWNER
Credential: MD
Phone: 718-382-6565