=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366197774
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPHA WELLCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2022
-----------------------------------------------------
Last Update Date | 02/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 E 38TH ST APT 9L
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-2765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-916-6419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 E 38TH ST APT 9L
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-2765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-353-1985
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. MODDY KILUVIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-353-1985
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------