Provider Demographics
NPI:1851652887
Name:CPW WELLNESS, INC
Entity Type:Organization
Organization Name:CPW WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BISSOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-877-1767
Mailing Address - Street 1:146 CENTRAL PARK W
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6297
Mailing Address - Country:US
Mailing Address - Phone:212-877-1767
Mailing Address - Fax:212-877-1971
Practice Address - Street 1:146 CENTRAL PARK W
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6297
Practice Address - Country:US
Practice Address - Phone:212-877-1767
Practice Address - Fax:212-877-1971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193423208D00000X
NY012786363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty