Provider Demographics
NPI:1619387636
Name:WELLNESS WEALTH AND WISDOM FOR MIND,BODY,SOUL
Entity Type:Organization
Organization Name:WELLNESS WEALTH AND WISDOM FOR MIND,BODY,SOUL
Other - Org Name:WELLNESS WEALTH AND WISDOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YEDIDAH
Authorized Official - Middle Name:TAMAR
Authorized Official - Last Name:YEHUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,CDN
Authorized Official - Phone:914-582-1928
Mailing Address - Street 1:121 VERNON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553
Mailing Address - Country:US
Mailing Address - Phone:914-582-1928
Mailing Address - Fax:
Practice Address - Street 1:121 VERNON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1811
Practice Address - Country:US
Practice Address - Phone:914-582-1928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004380-1251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare