Healthcare Provider Details

I. General information

NPI: 1770140725
Provider Name (Legal Business Name): WELLNY MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 W 45TH ST FL 9
NEW YORK NY
10036-4905
US

IV. Provider business mailing address

7 W 45TH ST FL 9
NEW YORK NY
10036-4905
US

V. Phone/Fax

Practice location:
  • Phone: 877-331-5043
  • Fax: 914-303-5004
Mailing address:
  • Phone: 877-331-5043
  • Fax: 914-303-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL K ROSEN
Title or Position: OWNER
Credential: MD
Phone: 877-331-5004