Healthcare Provider Details

I. General information

NPI: 1013518638
Provider Name (Legal Business Name): WELL MED MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140A WASHINGTON AVE
CEDARHURST NY
11516
US

IV. Provider business mailing address

670 MYRTLE AVE STE 198
BROOKLYN NY
11205-3923
US

V. Phone/Fax

Practice location:
  • Phone: 718-408-8860
  • Fax:
Mailing address:
  • Phone: 718-408-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NORMAN HALE KUPFERSTEIN
Title or Position: OWNER
Credential: MD
Phone: 718-408-8860