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General NPI Number Information
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NPI Number | 1932125721
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Entity Type | Organization
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Legal Business Name | WELLLIFE NETWORK INC.,
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 55 HORIZON DR
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City | HUNTINGTON
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State | NY
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Zip | 11743-4436
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Country | US
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Telephone | 631-920-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1985 MARCUS AVE STE 100
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-2025
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Country | US
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Telephone | 718-559-0516
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Fax | 718-762-6140
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Authorized Official
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Title or Position | CEO
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Name | SHERRY TUCKER
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Credential |
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Telephone | 718-559-0534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | NY
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