Healthcare Provider Details

I. General information

NPI: 1326092396
Provider Name (Legal Business Name): HEARTSHAREWELLNESS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 LIVINGSTON STREET LOWER LEVEL
BROOKLYN NY
11201-4859
US

IV. Provider business mailing address

177 LIVINGSTON STREET LOWER LEVEL
BROOKLYN NY
11201-4859
US

V. Phone/Fax

Practice location:
  • Phone: 718-855-7707
  • Fax: 718-855-7717
Mailing address:
  • Phone: 718-855-7707
  • Fax: 718-855-7717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000577-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF381397-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number009398-3
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number014362-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number007089-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number011875-1
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number163890-1
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number082372-1
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number127961-1
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number205290-1
License Number StateNY
# 11
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003927-1
License Number StateNY
# 12
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012668-1
License Number StateNY
# 13
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number016801-1
License Number StateNY
# 14
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number010626-1
License Number StateNY
# 15
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000959-1
License Number StateNY

VIII. Authorized Official

Name: JUDE ALEXANDRE
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 718-855-7707