=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851766539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHEELING FORWARD INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2015
-----------------------------------------------------
Last Update Date | 12/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1325 5TH AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-2660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-450-0077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2652 CROPSEY AVE APT 4C
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11214-6730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-450-0077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ALEX ELEGUDIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-450-0077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------