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General NPI Number Information
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NPI Number | 1518795202
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Entity Type | Organization
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Legal Business Name | WELLNESS OSTEOPATHIC FAMILY MEDICINE
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Dates
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Enumeration Date | 07/24/2024
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 6271 WOODHAVEN BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-2896
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Country | US
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Telephone | 347-338-0503
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Fax | 718-957-4668
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Provider Business Mailing Address
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Address Line | 6271 WOODHAVEN BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-2896
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Country | US
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Telephone | 347-338-0503
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Fax | 718-957-4668
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELISHEVA RUBINOVA
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Credential | DO
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Telephone | 347-338-0503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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