Healthcare Provider Details

I. General information

NPI: 1649848300
Provider Name (Legal Business Name): BELLE TERRE MEDICAL WELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 BELLE TERRE RD BLDG J
PORT JEFFERSON NY
11777-1936
US

IV. Provider business mailing address

640 BELLE TERRE RD BLDG J
PORT JEFFERSON NY
11777-1936
US

V. Phone/Fax

Practice location:
  • Phone: 631-828-5361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARKELLA CHRISTAKIS
Title or Position: OWNER
Credential: MD, MSPH
Phone: 631-403-4310