Provider Demographics
NPI:1609178219
Name:WELLISCH & WELLISCH
Entity Type:Organization
Organization Name:WELLISCH & WELLISCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-254-8875
Mailing Address - Street 1:7220 SW 164TH TER
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2536
Mailing Address - Country:US
Mailing Address - Phone:305-254-8875
Mailing Address - Fax:
Practice Address - Street 1:7220 SW 164TH TER
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-2536
Practice Address - Country:US
Practice Address - Phone:305-254-8875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty