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NPI Code Detail

MEDICARE: BE WELL PRIMARY HEALTH CARE CENTER, LLC

MEDICARE: BE WELL PRIMARY HEALTH CARE CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory
2261QM1300XMulti-Specialty Clinic/Center7001111RNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083623409
Entity Type Code : Organization
Provider Name (Legal Business Name) : BE WELL PRIMARY HEALTH CARE CENTER, LLC
Provider Business Mailing Address
First Line : 3007 FARRAGUT ROAD
Second Line :
City : BROOKLYN
State : NY
Zip : 11210-2549
Country : US
Telephone Number : 718-434-0711
Fax Number : 718-434-0712
Provider Business Practice Location Address
First Line : 3007 FARRAGUT ROAD
Second Line :
City : BROOKLYN
State : NY
Zip : 11210-2549
Country : US
Telephone Number : 718-434-0711
Fax Number : 718-434-0712
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. YEVGENIY STEPANKOVSKIY
Credential :
Telephone Number : 718-434-0711
Provider Enumeration Date : 08/05/2006
Last Update Date : 02/27/2024

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