Healthcare Provider Details

I. General information

NPI: 1386091932
Provider Name (Legal Business Name): DWELL MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 LONG BEACH RD 2ND FLOOR
OCEANSIDE NY
11572-2255
US

IV. Provider business mailing address

2710 LONG BEACH RD 2ND FLOOR
OCEANSIDE NY
11572-2255
US

V. Phone/Fax

Practice location:
  • Phone: 516-558-7858
  • Fax: 516-812-3975
Mailing address:
  • Phone: 516-558-7858
  • Fax: 516-812-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number185275
License Number StateNY

VIII. Authorized Official

Name: DR. A. BARTLEY BYRT
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 516-558-7858