Healthcare Provider Details

I. General information

NPI: 1407792658
Provider Name (Legal Business Name): WELL TELE-MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MADISON AVE FL 6
NEW YORK NY
10016-6795
US

IV. Provider business mailing address

9 BEAR TRL
JACKSON NJ
08527-2915
US

V. Phone/Fax

Practice location:
  • Phone: 718-540-7440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: AVRAHOM GURWITZ
Title or Position: OWNER
Credential:
Phone: 718-540-7440