Provider Demographics
NPI:1073786828
Name:WELLNESS HEALTH CARE & MEDICINE PLLC
Entity Type:Organization
Organization Name:WELLNESS HEALTH CARE & MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-886-8180
Mailing Address - Street 1:PO BOX 520281
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11352-0281
Mailing Address - Country:US
Mailing Address - Phone:718-886-8180
Mailing Address - Fax:
Practice Address - Street 1:17325 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5523
Practice Address - Country:US
Practice Address - Phone:718-886-8180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214330170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH38960Medicare UPIN
NY04556Medicare PIN