Healthcare Provider Details

I. General information

NPI: 1427822196
Provider Name (Legal Business Name): ALLWELL HEALTH MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4161 KISSENA BLVD STE C
FLUSHING NY
11355-3105
US

IV. Provider business mailing address

PO BOX 604675
BAYSIDE NY
11360-4675
US

V. Phone/Fax

Practice location:
  • Phone: 718-878-6920
  • Fax: 718-878-6920
Mailing address:
  • Phone: 718-878-6920
  • Fax: 718-878-6920

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 Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHUHUA SONG
Title or Position: MD
Credential: MD
Phone: 718-878-6920