Provider Demographics
NPI:1841969052
Name:THE HEALTH AND WELLNESS CLUB INC
Entity type:Organization
Organization Name:THE HEALTH AND WELLNESS CLUB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:YARDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-881-5389
Mailing Address - Street 1:5006 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3210
Mailing Address - Country:US
Mailing Address - Phone:347-881-5389
Mailing Address - Fax:
Practice Address - Street 1:5006 AVENUE L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3210
Practice Address - Country:US
Practice Address - Phone:347-881-5389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY519593OtherSTATE LICENSE NUMBER