SOUTHERN WELLCARE MEDICAL PC (NPI# 1396090932) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396090932 |
| Entity Type | Organization |
| Organization Name | SOUTHERN WELLCARE MEDICAL PC |
| Practice Address |
2336 Grand Concourse Bronx NY 10458-6903 |
| Practice Telephone | 7189070195 |
| Mailing Telephone | 7182200439 |
| Mailing Fax Number | 7189332914 |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2019-10-17 |
| Authorized Official Name | SVETLANA KHANDROS (PRESIDENT) |
| Authorized Official Telephone | 7182200439 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 228243 | NY | Allopathic & Osteopathic Physicians |
| Street Address |
2336 GRAND CONCOURSE |
| City | BRONX |
| State | NY |
| Zip Code | 10458-6903 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043505522 | Pinnacle Dental Care P.C. | Dentist | 2336 Grand Concourse, Bronx, NY 10458-6903 | 2011-06-13 |
| 1457900904 | Andrea Cummings | Registered Nurse | 2336 Grand Concourse, Bronx, NY 10458-6903 | 2019-09-07 |
| 1417469263 | Tanging D Sherpa | Physician Assistant | 2336 Grand Concourse, Bronx, NY 10458-6903 | 2017-11-02 |
| 1851848618 | Wellcare of Bx Medical PC | Family Medicine | 2336 Grand Concourse, Bronx, NY 10458-6903 | 2016-09-08 |
| 1184011728 | Maria A. Muniz | Dentist | 2336 Grand Concourse, Bronx, NY 10458-6903 | 2015-04-21 |
| 1497151476 | Shirley Carlos-cu | Nurse Practitioner | 2336 Grand Concourse, Bronx, NY 10458-6903 | 2014-11-18 |
| 1629486600 | Bronx Family Eye Care Inc | Optometrist | 2336 Grand Concourse, Bronx, NY 10458-6903 | 2014-07-23 |
| 1598006660 | Phelan Antonia Clancy | Registered Nurse | 2336 Grand Concourse, Bronx, NY 10458-6903 | 2013-03-13 |
| 1629319108 | Planet Pharmacy LLC | Pharmacy | 2336 Grand Concourse, Bronx, NY 10458-6903 | 2013-03-08 |
| 1811241631 | Grand Concourse Health Wellness Medical, PC | Pediatrics | 2336 Grand Concourse, Bronx, NY 10458-6903 | 2012-10-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154954493 | Belmont Medical PC | Specialist | 2525 Belmont Ave, Bronx, NY 10458 | 2020-02-14 |
| 1730731787 | Abreu Child and Parent Services Inc. | Speech-Language Pathologist | 2870 Marion Ave. Apt. 3c, Bronx, NY 10458 | 2019-07-10 |
| 1801457080 | Family Adult Day Care, Inc. | Clinic/Center | 2332 Hoffman Street, 2nd & 3rd Floor, Bronx, NY 10458 | 2019-06-27 |
| 1366005969 | Janet Jeonghwa Lee | Dentist | 260 E 188th Street, St. Barnabas Hospital, 1st Floor, Division of Orthodontics, Bronx, NY 10458 | 2019-04-18 |
| 1205308004 | Feben Kurban | Audiologist | 625 East Fordham Road, Bronx, NY 10458 | 2018-12-19 |
| 1306328737 | Lauretta Marie Tomaso | Nurse Practitioner | 500 East Fordham Road, Bronx, NY 10458 | 2018-09-01 |
| 1457831992 | Cinthia Isabel Morales | Counselor | 2488 Grandconcourse Suite 417, Bronx, NY 10458 | 2018-08-15 |
| 1588159156 | Raquel Lamarche | Student in an Organized Health Care Education/Training Program | 2505 Lorillard Pl Apt 1d, Bronx, NY 10458 | 2018-06-26 |
| 1750832929 | Classic Home Care, Inc. | In Home Supportive Care | 2655a Webster Avenue, 2nd Floor, Bronx, NY 10458 | 2016-10-21 |
| 1023565637 | Emily Hemingway | Physical Therapist | 397 E 198th St, Bronx, NY 10458 | 2016-09-01 |
| Find all providers in zip 10458 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700439031 | Cargill Comprehensive Care Services | Family Medicine | 1054 E 231st St, Bronx, NY 10466-4806 | 2019-07-16 |
| 1346775640 | Elena Hill | Family Medicine | 1276 Fulton Ave Fl 1, Bronx, NY 10456-3402 | 2017-04-24 |
| 1700337508 | Mayte Montufar | Family Medicine | 2136 Muliner Ave Fl 1, Bronx, NY 10462-2003 | 2016-10-18 |
| 1306296561 | Stephen Asiedu Medical Practice, P.C. | Family Medicine | 1245b Edward L Grant Hwy, Bronx, NY 10452-3101 | 2016-06-20 |
| 1336595008 | Chantal Nathalie Ogle | Family Medicine | 1054 Simpson St, Bronx, NY 10459-2404 | 2016-05-11 |
| 1811350242 | Jenna Medical Office PC | Family Medicine | 2742 Third Avenue, Bronx, NY 10455 | 2016-04-02 |
| 1235542549 | Welisane Bebe | Family Medicine | 1276 Fulton Ave, 4th Floor, Bronx Lebanon Hospital, Bronx, NY 10456 | 2014-06-04 |
| 1386081545 | Geoffrey Sheppard Dunn | Family Medicine | 68 E 161st St Fl 13, Bronx, NY 10451-2207 | 2013-05-29 |
| 1629413372 | Liliana Monica Taich | Family Medicine | 3050 Corlear Ave Ste 201, Bronx, NY 10463-5181 | 2013-05-08 |
| 1184968232 | Lwhmedical PC | Family Medicine | 1811 Hone Ave, Bronx, NY 10461-1406 | 2012-11-15 |
| Find all providers in BRONX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.