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General NPI Number Information
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NPI Number | 1861120974
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Entity Type | Organization
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Legal Business Name | HEART WELLNESS GROUP, LLC
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 2 BROADWAY
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City | NORTH HAVEN
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State | CT
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Zip | 06473-2349
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Country | US
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Telephone | 203-714-4441
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Fax |
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Provider Business Mailing Address
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Address Line | 6 OLD GATE RD
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City | WALLINGFORD
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State | CT
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Zip | 06492-3327
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Country | US
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Telephone | 917-582-8774
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KUNAL DOMAKONDA
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Credential | MD
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Telephone | 917-582-8774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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