Provider Demographics
NPI:1649889221
Name:WW MEDICAL WELLNESS PLLC
Entity type:Organization
Organization Name:WW MEDICAL WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERTHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-659-1716
Mailing Address - Street 1:118 GLEN COVE RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1718
Mailing Address - Country:US
Mailing Address - Phone:631-506-8907
Mailing Address - Fax:631-506-8909
Practice Address - Street 1:1105 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3107
Practice Address - Country:US
Practice Address - Phone:631-506-8907
Practice Address - Fax:631-506-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty