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NPI Code Detail

MEDICARE: WELLLIFE NETWORK INC.,

MEDICARE: WELLLIFE NETWORK 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
1261Q00000XClinic/CenterNY

General Provider Information

NPI Number : 1932125721
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLLIFE NETWORK INC.,
Provider Business Mailing Address
First Line : 1985 MARCUS AVE STE 100
Second Line :
City : NEW HYDE PARK
State : NY
Zip : 11042-2025
Country : US
Telephone Number : 718-559-0516
Fax Number : 718-762-6140
Provider Business Practice Location Address
First Line : 55 HORIZON DR
Second Line :
City : HUNTINGTON
State : NY
Zip : 11743-4436
Country : US
Telephone Number : 631-920-8000
Fax Number :
Authorized Official
Title or Position : CEO
Name : SHERRY TUCKER
Credential :
Telephone Number : 718-559-0534
Provider Enumeration Date : 07/14/2006
Last Update Date : 08/16/2024

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Directions to “WELLLIFE NETWORK INC., ” Practice Location

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