Healthcare Provider Details

I. General information

NPI: 1457516205
Provider Name (Legal Business Name): LAWRENCE M. WELLS, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20917 UNION TPKE
OAKLAND GARDENS NY
11364-3237
US

IV. Provider business mailing address

20917 UNION TPKE
OAKLAND GARDENS NY
11364-3237
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-2626
  • Fax: 718-464-2641
Mailing address:
  • Phone: 718-464-2626
  • Fax: 718-464-2641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number106532
License Number StateNY

VIII. Authorized Official

Name: DR. LAWRENCE M. WELLS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-464-2626