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General NPI Number Information
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NPI Number | 1740797661
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Entity Type | Individual
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Provider Name | LLEWELLYN JULIAN FORBES MSED
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Gender | Male
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Dates
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Enumeration Date | 12/30/2017
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Last Update Date | 12/30/2017
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Provider Practice Location Address
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Address Line | 15 IVES RD
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City | HEWLETT
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State | NY
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Zip | 11557-2034
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Country | US
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Telephone | 516-295-2019
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 METROPOLITAN AVE APT 10B
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City | BRONX
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State | NY
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Zip | 10462-6162
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Country | US
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Telephone | 646-302-4426
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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