Provider Demographics
NPI:1477804136
Name:WELLINGTON, CHRISTOPHER PHILANDO
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PHILANDO
Last Name:WELLINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ALCOTT PL
Mailing Address - Street 2:6E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4201
Mailing Address - Country:US
Mailing Address - Phone:347-520-4420
Mailing Address - Fax:
Practice Address - Street 1:120 ALCOTT PL
Practice Address - Street 2:6E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4201
Practice Address - Country:US
Practice Address - Phone:347-520-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170059915343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)