Provider Demographics
NPI:1184071367
Name:JERICHO WELLNESS LLC
Entity type:Organization
Organization Name:JERICHO WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FUMEI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-827-7798
Mailing Address - Street 1:55 JERICHO TPKE STE 102
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1013
Mailing Address - Country:US
Mailing Address - Phone:516-506-7888
Mailing Address - Fax:516-833-6044
Practice Address - Street 1:55 JERICHO TPKE STE 102
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1013
Practice Address - Country:US
Practice Address - Phone:516-506-7888
Practice Address - Fax:516-833-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty