| Community Wellness Physician PLLC | |
|
1471 Dekalb Ave Brooklyn NY 11237-3894 | |
| (347) 350-9344 | |
| (347) 240-4434 |
| Full Name | Community Wellness Physician PLLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 1471 Dekalb Ave, Brooklyn, New York |
| Authorized Official Name and Position | Gopi K Punukollu (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3473509344 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Wellness Physician PLLC 1471 Dekalb Ave Brooklyn NY 11237-3894 Ph: (347) 350-9344 | Community Wellness Physician PLLC 1471 Dekalb Ave Brooklyn NY 11237-3894 Ph: (347) 350-9344 |
| NPI Number | 1619315801 |
|---|---|
| Provider Enumeration Date | 06/10/2013 |
| Last Update Date | 06/10/2013 |
| Medicare PECOS PAC ID | 4486883477 |
|---|---|
| Medicare Enrollment ID | O20140218000284 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619315801 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Gopi K Punukollu |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1184839284 PECOS PAC ID: 9537250428 Enrollment ID: I20070829000048 |
| Provider Name | Hima B Punukollu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104989490 PECOS PAC ID: 6901944677 Enrollment ID: I20091118000052 |
| Provider Name | Keiko Leger |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1730516170 PECOS PAC ID: 2466777156 Enrollment ID: I20150223000848 |
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