Provider Demographics
NPI:1043466477
Name:HEALTHWELL MEDICAL, PC
Entity Type:Organization
Organization Name:HEALTHWELL MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FEI
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-886-1080
Mailing Address - Street 1:13235 41ST RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4113
Mailing Address - Country:US
Mailing Address - Phone:718-886-1080
Mailing Address - Fax:718-886-1081
Practice Address - Street 1:13235 41ST RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4113
Practice Address - Country:US
Practice Address - Phone:718-886-1080
Practice Address - Fax:718-886-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06876Medicare PIN
NYG100076258Medicare PIN