Provider Demographics
NPI:1538835574
Name:WELLNEXX, INC.
Entity type:Organization
Organization Name:WELLNEXX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WYCKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DHA, LMT
Authorized Official - Phone:631-214-6024
Mailing Address - Street 1:4 MEADOWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3829
Mailing Address - Country:US
Mailing Address - Phone:631-214-6024
Mailing Address - Fax:
Practice Address - Street 1:1930 VETERANS HIGHWAY SUITE 15
Practice Address - Street 2:ISLANDIA, NY 11749
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-214-6024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service