Provider Demographics
NPI:1568089985
Name:BP WELLNESS MEDICAL CARE PC
Entity Type:Organization
Organization Name:BP WELLNESS MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WERZBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-333-2424
Mailing Address - Street 1:3808 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3610
Mailing Address - Country:US
Mailing Address - Phone:718-972-2424
Mailing Address - Fax:
Practice Address - Street 1:3808 14TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3610
Practice Address - Country:US
Practice Address - Phone:718-972-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty