# MGF WELLNESS VISITS LLC

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

## Provider details

- **NPI number:** 1720453046
- **Authorized official:** MELANIE GAY FORMAN NP (ADULT NURSE PRACTITIONER)
- **Authorized official phone:** (516) 451-9355

## Contact information

- **Practice address:** 1618 PARK ST, ATLANTIC BEACH, NY 11509-1520
- **Practice address phone:** (516) 451-9355
- **Mailing address:** 1618 PARK ST, ATLANTIC BEACH, NY 11509-1520
- **Mailing address phone:** (516) 451-9355

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/11/2015
- **Last updated:** 12/11/2015