Provider Demographics
NPI:1275246738
Name:ML WELLNESS MEDICAL PLLC
Entity Type:Organization
Organization Name:ML WELLNESS MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSAMMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-474-5356
Mailing Address - Street 1:8 JAREDS PATH
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11719-9437
Mailing Address - Country:US
Mailing Address - Phone:516-474-5356
Mailing Address - Fax:
Practice Address - Street 1:277 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-4810
Practice Address - Country:US
Practice Address - Phone:516-474-5356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-29
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty