Healthcare Provider Details

I. General information

NPI: 1215402870
Provider Name (Legal Business Name): NY BE WELL MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E 46TH ST FL 9
NEW YORK NY
10017-9249
US

IV. Provider business mailing address

20 E 46TH ST FL 9
NEW YORK NY
10017-9249
US

V. Phone/Fax

Practice location:
  • Phone: 212-404-8090
  • Fax: 212-404-8091
Mailing address:
  • Phone: 212-404-8090
  • Fax: 212-404-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VARUZHAN DOVLATYAN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 212-404-8090