Provider Demographics
NPI:1841911245
Name:HEALTHWAY MEDICAL & AESTHETICS PA
Entity type:Organization
Organization Name:HEALTHWAY MEDICAL & AESTHETICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THE OSTEOPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LELCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-642-9026
Mailing Address - Street 1:6101 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-1141
Mailing Address - Country:US
Mailing Address - Phone:917-503-5354
Mailing Address - Fax:718-373-4699
Practice Address - Street 1:6101 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1141
Practice Address - Country:US
Practice Address - Phone:917-503-5354
Practice Address - Fax:718-373-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty