Healthcare Provider Details

I. General information

NPI: 1558716647
Provider Name (Legal Business Name): WELLNESS-WISE TUTORING AND CONSULTATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ELZEY AVE AVENUE
ELMONT NY
11003-1529
US

IV. Provider business mailing address

220 ELZEY AVE AVENUE
ELMONT NY
11003-1529
US

V. Phone/Fax

Practice location:
  • Phone: 646-621-0331
  • Fax: 516-706-7045
Mailing address:
  • Phone: 646-621-0331
  • Fax: 516-706-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. WILFORD HYATT
Title or Position: DIRECTOR/PROVIDER
Credential: M.S. ED., ND
Phone: 646-621-0331