Healthcare Provider Details

I. General information

NPI: 1215531173
Provider Name (Legal Business Name): WELL-CHOICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2020
Last Update Date: 11/22/2020
Certification Date: 11/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N GOULD ST STE R
SHERIDAN WY
82801-6317
US

IV. Provider business mailing address

1329 WASHINGTON AVE
WEST ISLIP NY
11795-1625
US

V. Phone/Fax

Practice location:
  • Phone: 631-213-7190
  • Fax:
Mailing address:
  • Phone: 631-260-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: TREVOR FOSTER
Title or Position: PRESIDENT
Credential:
Phone: 631-213-7190