# WELLCARE MEDICAL OF LONG ISLAND PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pure Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114508587
- **Authorized official:** EVAN B. SHAPIRO MD (OWNER)
- **Authorized official phone:** (516) 680-3900

## Contact information

- **Practice address:** 85 S OCEAN AVE, PATCHOGUE, NY 11772-3702
- **Practice address phone:** (516) 412-7873
- **Mailing address:** 1300 UNION TPKE STE 206, NEW HYDE PARK, NY 11040-1759
- **Mailing address phone:** (516) 680-3900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/17/2021
- **Last updated:** 12/09/2022