Organization
CHUNGDAM WELLNESS GROUP,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA PERSAUD M.D (MEDICAL DIRECTOR)
(212) 685-1004
Entity
Organization
Contact information
Practice address
315 5TH AVE STE 1001, NEW YORK, NY 10016-6510
(212) 685-1004
(212) 685-1007
Mailing address
315 5TH AVE STE 1001, NEW YORK, NY 10016-6510
(212) 685-1004
(212) 685-1007
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
004553
NY
261QP2000X
Physical Therapy Clinic/Center
032406
NY
261QP2300X
Primary Care Clinic/Center
Primary
254812
NY
Other
Enumeration date
10/04/2011
Last updated
10/04/2011
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