Organization
LEVIATHAN WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEILA WILSON (MANAGER)
(917) 612-7485
Entity
Organization
Contact information
Practice address
55 E OLD COUNTRY RD, HICKSVILLE, NY 11801-4293
(516) 987-6428
Mailing address
1584 86TH ST, BROOKLYN, NY 11228-3433
(718) 621-5800
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
09/23/2022
Last updated
09/23/2022
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