Provider Demographics
NPI:1922326263
Name:EVERWELL MEDICAL P.C.
Entity Type:Organization
Organization Name:EVERWELL MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:718-730-2530
Mailing Address - Street 1:839 58TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3679
Mailing Address - Country:US
Mailing Address - Phone:718-686-6889
Mailing Address - Fax:718-686-6877
Practice Address - Street 1:839 58TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3679
Practice Address - Country:US
Practice Address - Phone:718-686-6889
Practice Address - Fax:718-686-6877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02716549Medicaid
NY02716549Medicaid