Healthcare Provider Details

I. General information

NPI: 1528614369
Provider Name (Legal Business Name): STRONG CHILDREN WELLNESS MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16318 JAMAICA AVE STE 2
JAMAICA NY
11432-4901
US

IV. Provider business mailing address

420 WOLF HILL RD
DIX HILLS NY
11746-5742
US

V. Phone/Fax

Practice location:
  • Phone: 718-450-9242
  • Fax:
Mailing address:
  • Phone: 919-491-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SUZETTE N BROWN
Title or Position: CHIEF OPERATING OFFICER
Credential: MD
Phone: 919-491-3448