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General NPI Number Information
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NPI Number | 1851652887
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Entity Type | Organization
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Legal Business Name | CPW WELLNESS, INC
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 146 CENTRAL PARK W SUITE 1D
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City | NEW YORK
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State | NY
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Zip | 10023-6297
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Country | US
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Telephone | 212-877-1767
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Fax | 212-877-1971
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Provider Business Mailing Address
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Address Line | 146 CENTRAL PARK W SUITE 1D
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City | NEW YORK
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State | NY
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Zip | 10023-6297
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Country | US
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Telephone | 212-877-1767
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Fax | 212-877-1971
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Authorized Official
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Title or Position | OFFICER
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Name | LIONEL BISSOON
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Credential | MD
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Telephone | 212-877-1767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 012786
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 193423
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License Number State | NY
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