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General NPI Number Information
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NPI Number | 1861983363
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Entity Type | Organization
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Legal Business Name | GARDEN OF WELLNESS LIFE MEDICAL PC
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 8027 135 STREET
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City | QUEENS
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State | NY
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Zip | 11435
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Country | US
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Telephone | 347-561-3120
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Fax | 347-561-3142
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Provider Business Mailing Address
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Address Line | 8027 135 STREET
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City | QUEENS
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State | NY
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Zip | 11435
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Country | US
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Telephone | 347-561-3120
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Fax | 347-561-3142
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. PHYLLIS MARTHA GELB
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Credential | MD
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Telephone | 347-561-3120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 202216-1
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License Number State | NY
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