Provider Demographics
NPI:1487303913
Name:EMPIRICAL MEDICAL AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:EMPIRICAL MEDICAL AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEKULEO
Authorized Official - Middle Name:
Authorized Official - Last Name:GATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-343-7144
Mailing Address - Street 1:283 COMMACK RD STE 207
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3400
Mailing Address - Country:US
Mailing Address - Phone:631-343-7144
Mailing Address - Fax:631-670-7035
Practice Address - Street 1:283 COMMACK RD STE 207
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3400
Practice Address - Country:US
Practice Address - Phone:631-343-7144
Practice Address - Fax:631-670-7035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty