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General NPI Number Information
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NPI Number | 1164963914
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Entity Type | Organization
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Legal Business Name | NEW YORK WELLNESS,LLC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 9 E 45TH ST 6TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10017-2425
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Country | US
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Telephone | 212-401-0602
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Fax |
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Provider Business Mailing Address
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Address Line | 11825 STATE ROUTE 40 STE. #100
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City | DUNLAP
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State | IL
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Zip | 61525-8842
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Country | US
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Telephone | 309-839-9943
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Fax | 309-839-9943
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICK M MOBILIA
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Credential | D.D.S
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Telephone | 212-401-0602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 043050
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License Number State | NY
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