MEDICARE: INTERNAL MEDICINE WELLBEING PLLC

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
1	207R00000X	Internal Medicine Physician
2	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1205526472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE WELLBEING PLLC

Provider Business Mailing Address
First Line	:	8713 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7847
Country	:	US
Telephone Number	:	718-971-9509
Fax Number	:	718-971-1698

Provider Business Practice Location Address
First Line	:	8713 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7847
Country	:	US
Telephone Number	:	718-971-9509
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEKSEY ETINGER
Credential	:	DO
Telephone Number	:	718-971-9509

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	10/04/2025

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