MEDICARE: VITALCHECK WELLNESS

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	2083C0008X	Clinical Informatics Physician

General Provider Information

NPI Number	:	1770213621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALCHECK WELLNESS

Provider Business Mailing Address
First Line	:	241 W 37TH ST RM 402
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-6818
Country	:	US
Telephone Number	:	312-912-2408
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 W 37TH ST RM 402
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-6818
Country	:	US
Telephone Number	:	312-912-2408
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. AMIR MANSOUR
Credential	:
Telephone Number	:	312-912-2408

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	06/14/2022

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Directions to “VITALCHECK WELLNESS ” Practice Location

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