| Functional Wellness Medical Care PLLC | |
|
16055 Cross Bay Blvd Unit A Howard Beach NY 11414-3450 | |
| (718) 210-4738 | |
| (888) 498-4123 |
| Full Name | Functional Wellness Medical Care PLLC |
|---|---|
| Speciality | Family Medicine |
| Location | 16055 Cross Bay Blvd, Howard Beach, New York |
| Authorized Official Name and Position | Hamza Jalal (OWNER) |
| Authorized Official Contact | 6315729139 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Functional Wellness Medical Care PLLC 16055 Cross Bay Blvd Unit A Howard Beach NY 11414-3450 Ph: (718) 210-4738 | Functional Wellness Medical Care PLLC 16055 Cross Bay Blvd Unit A Howard Beach NY 11414-3450 Ph: (718) 210-4738 |
| NPI Number | 1164149001 |
|---|---|
| Provider Enumeration Date | 10/21/2022 |
| Last Update Date | 09/25/2024 |
| Certification Date | 09/25/2024 |
| Medicare PECOS PAC ID | 0547637068 |
|---|---|
| Medicare Enrollment ID | O20221111001918 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164149001 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Hamza Jalal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164910667 PECOS PAC ID: 7719223221 Enrollment ID: I20210611000110 |
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