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General NPI Number Information
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NPI Number | 1952639924
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Entity Type | Organization
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Legal Business Name | ST BARNABAS WELL CARE PC
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Dates
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Enumeration Date | 12/02/2009
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 2595 WEBSTER AVE
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City | BRONX
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State | NY
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Zip | 10458-4806
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Country | US
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Telephone | 718-561-1104
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Fax | 718-561-1105
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Provider Business Mailing Address
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Address Line | 2595 WEBSTER AVE
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City | BRONX
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State | NY
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Zip | 10458-4806
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Country | US
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Telephone | 718-561-1104
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Fax | 718-561-1105
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHANTAL HILAIRE
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Credential | MD
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Telephone | 718-561-1104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 220001
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License Number State | NY
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