Healthcare Provider Details

I. General information

NPI: 1770530057
Provider Name (Legal Business Name): STEPHANIE WELLINGTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 HICKS STREET
BROOKLYN NY
11201
US

IV. Provider business mailing address

160 WATER STREET 20TH FLOOR
NEW YORK NY
10039
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-1832
  • Fax:
Mailing address:
  • Phone: 212-256-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number206516
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: