Healthcare Provider Details

I. General information

NPI: 1629633839
Provider Name (Legal Business Name): ADVANCE WELLNESS SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CARLETON AVE STE 2
ISLIP TERRACE NY
11752-2236
US

IV. Provider business mailing address

763 EASTERN PKWY APT E17
BROOKLYN NY
11213-3417
US

V. Phone/Fax

Practice location:
  • Phone: 631-816-8054
  • Fax:
Mailing address:
  • Phone: 631-816-8054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. CINDY-ANNE WILLIAMS
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 631-816-8054