MEDICARE: NUIMAGE WELLNESS SERVICES INC

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	251E00000X	Home Health Agency
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1497353379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUIMAGE WELLNESS SERVICES INC

Provider Business Mailing Address
First Line	:	207 W CENTENNIAL AVE
Second Line	:
City	:	ROOSEVELT
State	:	NY
Zip	:	11575-1928
Country	:	US
Telephone Number	:	516-263-4264
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 WILSON ST STE 2
Second Line	:
City	:	WEST HEMPSTEAD
State	:	NY
Zip	:	11552-2019
Country	:	US
Telephone Number	:	162-634-2645
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIFFANY PRIESTER
Credential	:	NP
Telephone Number	:	516-263-4264

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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