Healthcare Provider Details

I. General information

NPI: 1083623409
Provider Name (Legal Business Name): BE WELL PRIMARY HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 FARRAGUT ROAD
BROOKLYN NY
11210-2549
US

IV. Provider business mailing address

3007 FARRAGUT RD
BROOKLYN NY
11210-1537
US

V. Phone/Fax

Practice location:
  • Phone: 718-434-0711
  • Fax: 718-434-0712
Mailing address:
  • Phone: 718-434-0711
  • Fax: 718-434-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number7001111R
License Number StateNY

VIII. Authorized Official

Name: MR. YEVGENIY STEPANKOVSKIY
Title or Position: CEO
Credential:
Phone: 718-253-1582