Basic Information
| Provider Information | |||||||||
| NPI: | 1326092396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTSHAREWELLNESS LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 177 LIVINGSTON STREET | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112014859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188557707 | ||||||||
| FaxNumber: | 7188557717 | ||||||||
| Practice Location | |||||||||
| Address1: | 177 LIVINGSTON STREET | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112014859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188557707 | ||||||||
| FaxNumber: | 7188557717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 08/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | ALEXANDRE | ||||||||
| AuthorizedOfficialFirstName: | JUDE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINIC DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7188557707 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 014362-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 103T00000X | 007089-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 103TM1800X | 011875-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities | 207R00000X | 163890-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 2084P0800X | 082372-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 127961-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 205290-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 213E00000X | N003927-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 225100000X | 012668-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 016801-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | 010626-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 231H00000X | 000959-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 363A00000X | 000577-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | F381397-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 103T00000X | 009398-3 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | W39641 | 01 | NY | MEDICARE PTAN | OTHER | 02087016 | 05 | NY | MEDICAID |