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General NPI Number Information
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NPI Number | 1669306551
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Entity Type | Organization
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Legal Business Name | TRESTLE CARE MEDICAL PLLC
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Dates
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Enumeration Date | 06/09/2026
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Last Update Date | 06/09/2026
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Provider Practice Location Address
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Address Line | 2823 3RD AVE STE 104
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City | BRONX
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State | NY
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Zip | 10455-1057
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Country | US
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Telephone | 212-748-9208
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 PENNSYLVANIA AVE STE 105A
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City | WILMINGTON
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State | DE
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Zip | 19806-4125
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Country | US
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Telephone | 212-748-9208
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Fax | 800-497-7434
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Authorized Official
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Title or Position | MEMBER
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Name | DR. WASEEM GHANNAM
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Credential | MD
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Telephone | 212-748-9208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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