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General NPI Number Information
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NPI Number | 1104427442
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Entity Type | Organization
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Legal Business Name | MEDICAL AND WELLNESS PRACTICE PLLC
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 554 TOMPKINS AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-1745
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Country | US
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Telephone | 877-241-2772
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 103
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City | HILLSDALE
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State | NJ
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Zip | 07642-0103
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Country | US
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Telephone | 201-522-3205
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN SOU-CHENG SHIAU
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Credential | MD
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Telephone | 917-886-5276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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