Basic Information
| Provider Information | |||||||||
| NPI: | 1699167023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTSHARE WELLNESS,LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 177 LIVINGSTON STREET | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188557707 | ||||||||
| FaxNumber: | 7188557717 | ||||||||
| Practice Location | |||||||||
| Address1: | 177 LIVINGSTON STREET | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188557707 | ||||||||
| FaxNumber: | 7188557717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2015 | ||||||||
| LastUpdateDate: | 08/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | ALEXANDRE | ||||||||
| AuthorizedOfficialFirstName: | JUDE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR CLINIC DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7188557707 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | Y | Agencies | Public Health or Welfare |
No ID Information.