Provider Demographics
NPI:1518208750
Name:WHOLE HEALTHY FAMILY
Entity Type:Organization
Organization Name:WHOLE HEALTHY FAMILY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-221-1212
Mailing Address - Street 1:2874 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5726
Mailing Address - Country:US
Mailing Address - Phone:516-221-1212
Mailing Address - Fax:516-221-1292
Practice Address - Street 1:2874 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5726
Practice Address - Country:US
Practice Address - Phone:516-221-1212
Practice Address - Fax:516-221-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1934232081S0010X
NY012786363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty