Healthcare Provider Details

I. General information

NPI: 1679308738
Provider Name (Legal Business Name): BILLWELL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 NORFOLK ST
BROOKLYN NY
11235-2306
US

IV. Provider business mailing address

178 NORFOLK ST
BROOKLYN NY
11235-2306
US

V. Phone/Fax

Practice location:
  • Phone: 917-318-2223
  • Fax:
Mailing address:
  • Phone: 917-318-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: NATALIE MASHKEVICH
Title or Position: MANAGER
Credential:
Phone: 917-318-2233