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General NPI Number Information
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NPI Number | 1306019765
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Entity Type | Organization
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Legal Business Name | HEALTH & WELLNESS FAMILY PRACTICE SERVICE PC
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 11481 177TH PL
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City | JAMAICA
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State | NY
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Zip | 11434-1405
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Country | US
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Telephone | 718-658-6767
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Fax | 718-206-0861
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Provider Business Mailing Address
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Address Line | 11481 177TH PL
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City | JAMAICA
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State | NY
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Zip | 11434-1405
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Country | US
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Telephone | 718-658-6767
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Fax | 718-206-0861
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SONIA EVADNE WALKER-ADAMSON
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Credential | D.O
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Telephone | 718-658-6767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 197679
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License Number State | NY
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