# COMMUNITY MEDICAL WELLNESS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073002473
- **Authorized official:** MR. CHRISTOPHER DEFILIPPIS (OPERATIONS MANAGER)
- **Authorized official phone:** (516) 314-5377

## Contact information

- **Practice address:** 1041 ROUTE 112, PORT JEFFERSON STATION, NY 11776-6000
- **Practice address phone:** (516) 314-5377
- **Mailing address:** PO BOX 463, FARMINGVILLE, NY 11738-0463

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | 276810-1 | NY | Yes |

## Other

- **Enumeration date:** 05/02/2018
- **Last updated:** 05/02/2018