MEDICARE: HEARTSHAREWELLNESS LTD

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	103T00000X	Psychologist	014362-1	NY
2	103T00000X	Psychologist	007089-1	NY
3	103TM1800X	Intellectual & Developmental Disabilities Psychologist	011875-1	NY
4	207R00000X	Internal Medicine Physician	163890-1	NY
5	2084P0800X	Psychiatry Physician	082372-1	NY
6	2084P0800X	Psychiatry Physician	127961-1	NY
7	2084P0800X	Psychiatry Physician	205290-1	NY
8	213E00000X	Podiatrist	N003927-1	NY
9	225100000X	Physical Therapist	012668-1	NY
10	225100000X	Physical Therapist	016801-1	NY
11	225X00000X	Occupational Therapist	010626-1	NY
12	231H00000X	Audiologist	000959-1	NY
13	363A00000X	Physician Assistant	000577-1	NY
14	363L00000X	Nurse Practitioner	F381397-1	NY
15	103T00000X	Psychologist	009398-3	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W39641	OTHER	NY	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1326092396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTSHAREWELLNESS LTD

Provider Business Mailing Address
First Line	:	177 LIVINGSTON STREET
Second Line	:	LOWER LEVEL
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4859
Country	:	US
Telephone Number	:	718-855-7707
Fax Number	:	718-855-7717

Provider Business Practice Location Address
First Line	:	177 LIVINGSTON STREET
Second Line	:	LOWER LEVEL
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4859
Country	:	US
Telephone Number	:	718-855-7707
Fax Number	:	718-855-7717

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	JUDE ALEXANDRE
Credential	:
Telephone Number	:	718-855-7707

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	08/14/2015

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Directions to “HEARTSHAREWELLNESS LTD ” Practice Location

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