Provider Demographics
NPI:1023888765
Name:WELLINGTON OFFICE BASED SURGICAL PRACTICE, PLLC
Entity type:Organization
Organization Name:WELLINGTON OFFICE BASED SURGICAL PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-828-9906
Mailing Address - Street 1:110 EAST 87TH STREET
Mailing Address - Street 2:#1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4102
Mailing Address - Country:US
Mailing Address - Phone:212-828-9906
Mailing Address - Fax:
Practice Address - Street 1:110 EAST 87TH STREET
Practice Address - Street 2:#1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4102
Practice Address - Country:US
Practice Address - Phone:212-828-9906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty