Provider Demographics
NPI:1205604113
Name:NORTHWELL HEALTH MEDICAL, INC
Entity type:Organization
Organization Name:NORTHWELL HEALTH MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-475-5700
Mailing Address - Street 1:1411 N FLAGLER DR STE 7100
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3418
Mailing Address - Country:US
Mailing Address - Phone:561-475-5700
Mailing Address - Fax:877-550-1796
Practice Address - Street 1:1411 N FLAGLER DR STE 7100
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3418
Practice Address - Country:US
Practice Address - Phone:561-475-5700
Practice Address - Fax:877-550-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty