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General NPI Number Information
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NPI Number | 1205604113
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Entity Type | Organization
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Legal Business Name | NORTHWELL HEALTH MEDICAL, INC
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 1411 N FLAGLER DR STE 7100
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3418
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Country | US
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Telephone | 561-475-5700
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Fax | 877-550-1796
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Provider Business Mailing Address
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Address Line | 1411 N FLAGLER DR STE 7100
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3418
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Country | US
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Telephone | 561-475-5700
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Fax | 877-550-1796
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. NICOLE BASILE
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Credential | MD
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Telephone | 561-475-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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