Healthcare Provider Details

I. General information

NPI: 1720887649
Provider Name (Legal Business Name): VIRTUAL WELLNESS AND HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14728 90TH AVE APT 5H
JAMAICA NY
11435-3706
US

IV. Provider business mailing address

14728 90TH AVE APT 5H
JAMAICA NY
11435-3706
US

V. Phone/Fax

Practice location:
  • Phone: 346-758-1734
  • Fax:
Mailing address:
  • Phone: 346-758-1734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHANY CORPORAN
Title or Position: OWNER
Credential: MD
Phone: 346-758-1734