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General NPI Number Information
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NPI Number | 1043035025
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Entity Type | Organization
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Legal Business Name | INTEGRATED WELLNESS, NP IN ADULT HEALTH, PC
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 990 STEWART AVE STE LL30
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City | GARDEN CITY
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State | NY
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Zip | 11530-4822
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Country | US
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Telephone | 516-280-9600
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Fax | 516-280-9599
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Provider Business Mailing Address
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Address Line | 990 STEWART AVE STE LL30
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City | GARDEN CITY
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State | NY
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Zip | 11530-4822
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Country | US
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Telephone | 516-280-9600
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JARRETT BUDA
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Credential |
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Telephone | 516-280-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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