Provider Demographics
NPI:1548617426
Name:WELLNESS MEDICAL SUPPLY CORP.
Entity Type:Organization
Organization Name:WELLNESS MEDICAL SUPPLY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-296-1434
Mailing Address - Street 1:894 FAIRMOUNT PL APT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4284
Mailing Address - Country:US
Mailing Address - Phone:646-632-2070
Mailing Address - Fax:
Practice Address - Street 1:894 FAIRMOUNT PL APT 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4284
Practice Address - Country:US
Practice Address - Phone:646-632-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies