1780817304 NPI number — PARTNERS FOR WELLNESS AGENCIES, INC.

Table of content: DR. CHAD MICHAEL RONHOLM M.D. (NPI 1306027909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780817304 NPI number — PARTNERS FOR WELLNESS AGENCIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTNERS FOR WELLNESS AGENCIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780817304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 120217
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT ALBANS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11412-0217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-451-0787
Provider Business Mailing Address Fax Number:
516-209-4567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
147 BLEECKER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11221-3961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-451-0787
Provider Business Practice Location Address Fax Number:
516-209-4567
Provider Enumeration Date:
08/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
DWON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
516-451-0787

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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