Healthcare Provider Details

I. General information

NPI: 1326753971
Provider Name (Legal Business Name): MICHAEL WELLS PA-C, R.T. (R)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 HEMPSTEAD TPKE
EAST MEADOW NY
11554-2035
US

IV. Provider business mailing address

823 HELENE ST
WANTAGH NY
11793-1623
US

V. Phone/Fax

Practice location:
  • Phone: 516-595-0206
  • Fax:
Mailing address:
  • Phone: 516-796-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: