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General NPI Number Information
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NPI Number | 1386091932
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Entity Type | Organization
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Legal Business Name | DWELL MEDICAL GROUP PC
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 06/20/2017
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Provider Practice Location Address
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Address Line | 2710 LONG BEACH RD 2ND FLOOR
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City | OCEANSIDE
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State | NY
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Zip | 11572-2255
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Country | US
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Telephone | 516-558-7858
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Fax | 516-812-3975
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Provider Business Mailing Address
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Address Line | 2710 LONG BEACH RD 2ND FLOOR
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City | OCEANSIDE
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State | NY
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Zip | 11572-2255
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Country | US
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Telephone | 516-558-7858
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Fax | 516-812-3975
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. A. BARTLEY BYRT
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Credential | MD
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Telephone | 516-558-7858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 185275
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License Number State | NY
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