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Organization
SOUTHERN WELLCARE MEDICAL PC
Active
Organization
SOUTHERN WELLCARE MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SVETLANA KHANDROS D.O. (PRESIDENT)
(718) 220-0439
Entity
Organization
Contact information
Practice address
2336 GRAND CONCOURSE, BRONX, NY 10458-6903
(718) 907-0195
Mailing address
2336 GRAND CONCOURSE, BRONX, NY 10458-6903
(718) 220-0439
(718) 933-2914
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
228243
NY
Other
Enumeration date
07/19/2012
Last updated
10/17/2019
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