Provider Demographics
NPI:1710397849
Name:WELLNESS HOUSECALLS MANAGEMENT,LLC
Entity Type:Organization
Organization Name:WELLNESS HOUSECALLS MANAGEMENT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CUMANDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANGUSTIA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-644-6944
Mailing Address - Street 1:385 SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1340
Mailing Address - Country:US
Mailing Address - Phone:718-821-1222
Mailing Address - Fax:718-418-7490
Practice Address - Street 1:385 SENECA AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1340
Practice Address - Country:US
Practice Address - Phone:718-821-1222
Practice Address - Fax:718-418-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337028171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty