Healthcare Provider Details

I. General information

NPI: 1740797661
Provider Name (Legal Business Name): LLEWELLYN JULIAN FORBES MSED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2017
Last Update Date: 12/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 IVES RD
HEWLETT NY
11557-2034
US

IV. Provider business mailing address

1501 METROPOLITAN AVE APT 10B
BRONX NY
10462-6162
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-2019
  • Fax:
Mailing address:
  • Phone: 646-302-4426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: