Healthcare Provider Details

I. General information

NPI: 1154350361
Provider Name (Legal Business Name): SVS WELLCARE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7616 BAY PARKWAY 1 FL
BROOKLYN NY
11214-1516
US

IV. Provider business mailing address

7616 BAY PARKWAY 1 FL
BROOKLYN NY
11214-1516
US

V. Phone/Fax

Practice location:
  • Phone: 718-837-7400
  • Fax: 718-837-7402
Mailing address:
  • Phone: 718-837-7400
  • Fax: 718-837-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number186334
License Number StateNY

VIII. Authorized Official

Name: SERGEY SHELIKHOV
Title or Position: ORGANIZER
Credential:
Phone: 718-837-7400