Provider Demographics
NPI:1164285664
Name:NM WELLNESS IN FAMILY HEALTH NP PLLC
Entity Type:Organization
Organization Name:NM WELLNESS IN FAMILY HEALTH NP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIAS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:646-326-3277
Mailing Address - Street 1:2021 HOLLAND AVE APT 4H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2974
Mailing Address - Country:US
Mailing Address - Phone:646-326-3277
Mailing Address - Fax:
Practice Address - Street 1:4310 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3102
Practice Address - Country:US
Practice Address - Phone:646-326-3277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty