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General NPI Number Information
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NPI Number | 1518740943
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Entity Type | Organization
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Legal Business Name | MODERN WELLNESS NP IN FAMILY HEALTH PLLC
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 100 DUFFY AVE STE 510
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City | HICKSVILLE
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State | NY
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Zip | 11801-3636
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Country | US
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Telephone | 631-505-1156
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Fax |
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Provider Business Mailing Address
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Address Line | 100 DUFFY AVE STE 510
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City | HICKSVILLE
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State | NY
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Zip | 11801-3636
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ASHLEY VALEUS
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Credential |
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Telephone | 631-505-1156
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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 |
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License Number State |
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