| Southern Wellcare Medical Pc | |
|
2336 Grand Concourse Bronx NY 10458-6903 | |
| (718) 907-0195 | |
| Not Available |
| Full Name | Southern Wellcare Medical Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 2336 Grand Concourse, Bronx, New York |
| Authorized Official Name and Position | Svetlana Khandros (PRESIDENT) |
| Authorized Official Contact | 7182200439 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Wellcare Medical Pc 2336 Grand Concourse Bronx NY 10458-6903 Ph: (718) 220-0439 | Southern Wellcare Medical Pc 2336 Grand Concourse Bronx NY 10458-6903 Ph: (718) 907-0195 |
| NPI Number | 1396090932 |
|---|---|
| Provider Enumeration Date | 07/19/2012 |
| Last Update Date | 10/17/2019 |
| Medicare PECOS PAC ID | 9335363548 |
|---|---|
| Medicare Enrollment ID | O20140610000014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396090932 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 228243 (New York) | Primary |
| Provider Name | Svetlana Khandros |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871578872 PECOS PAC ID: 0345132080 Enrollment ID: I20040326000961 |
| Provider Name | Elaine R Williams |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1710959945 PECOS PAC ID: 4082606561 Enrollment ID: I20040402000629 |
| Provider Name | Faina Solominskaya |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063513935 PECOS PAC ID: 4183649452 Enrollment ID: I20051006000421 |
| Provider Name | Billy Ford |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1871524538 PECOS PAC ID: 4486675063 Enrollment ID: I20051210000083 |
| Provider Name | Madeline Cruz |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1043390131 PECOS PAC ID: 2062500242 Enrollment ID: I20071126000132 |
| Provider Name | Jose Paul Loor |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1982906723 PECOS PAC ID: 4880864875 Enrollment ID: I20120920000071 |
| Provider Name | Pramod Sanghi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1285845370 PECOS PAC ID: 0547354003 Enrollment ID: I20151005002185 |
| Provider Name | Bo T Headlam |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1619939246 PECOS PAC ID: 8820074883 Enrollment ID: I20161208001663 |
| Provider Name | Phelan Antonia Clancy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598006660 PECOS PAC ID: 2567711781 Enrollment ID: I20180822000550 |
| Provider Name | Jacqueline Lamond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124567300 PECOS PAC ID: 1456602549 Enrollment ID: I20181001000150 |
| Provider Name | Andrea Cummings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457900904 PECOS PAC ID: 3072948629 Enrollment ID: I20200109000367 |
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