Healthcare Provider Details

I. General information

NPI: 1629367941
Provider Name (Legal Business Name): WELLCARE PEDIATRICS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 FRANCIS LEWIS BLVD
WHITESTONE NY
11357-3247
US

IV. Provider business mailing address

1720 FRANCIS LEWIS BLVD
WHITESTONE NY
11357-3247
US

V. Phone/Fax

Practice location:
  • Phone: 718-939-4379
  • Fax: 718-939-4380
Mailing address:
  • Phone: 718-939-4379
  • Fax: 718-939-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number236631
License Number StateNY

VIII. Authorized Official

Name: DR. IBRAHIM CARVAN
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 718-939-4379