Provider Demographics
NPI:1952639924
Name:ST BARNABAS WELL CARE PC
Entity Type:Organization
Organization Name:ST BARNABAS WELL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HILAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-561-1104
Mailing Address - Street 1:2595 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4806
Mailing Address - Country:US
Mailing Address - Phone:718-561-1104
Mailing Address - Fax:718-561-1105
Practice Address - Street 1:2595 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4806
Practice Address - Country:US
Practice Address - Phone:718-561-1104
Practice Address - Fax:718-561-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2200012081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty