Provider Demographics
NPI:1740057207
Name:VIRTUALLY WELL LLC
Entity type:Organization
Organization Name:VIRTUALLY WELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-745-9724
Mailing Address - Street 1:42 WHITNEY LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-1337
Mailing Address - Country:US
Mailing Address - Phone:203-745-9724
Mailing Address - Fax:
Practice Address - Street 1:415 BOSTON POST RD STE 3-1165
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2578
Practice Address - Country:US
Practice Address - Phone:203-745-9724
Practice Address - Fax:888-960-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service