Glow Wellness Care Medical PLLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

GLOW WELLNESS CARE MEDICAL PLLC

Practice address

3027 Jericho Tpke
East Northport, NY 11731-6230

Phone

(516) 665-1476

Fax

(516) 620-3773

NPI assigned

Jun 12, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shahab KhanNPI 1962812552

Title

MD

Phone

(347) 476-7399

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shahab A Khan, M.D.

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1962812552
  Medicare reassignment Care Compare group NPD Authorized official
• Seyyar Ahmad Khan

  • Nephrology Physician
  • Jackson Heights, NY
  • NPI 1831429406
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1245072909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3027 JERICHO TPKE",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117316230",
            "telephone_number": "516-665-1476",
            "fax_number": "516-620-3773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3027 JERICHO TPKE",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117316230",
            "telephone_number": "516-665-1476",
            "fax_number": "516-620-3773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLOW WELLNESS CARE MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-12",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "SHAHAB",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "347-476-7399"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan Gilbert
• Holly Giovi, RN
• Robert Vincent Giudice, MS, OTR/L
• Anita Glashow
• Susan Glover
• Theodore Lyle Goldman, M.D.
• Miaomiao Gong
• Diane L. Gorenstein, LCSW
• Dianna R Gott, LCSW
• Martin I Granoff, MD

• Nephrology Physician in East Northport, NY
• Providers in East Northport, NY by specialty
• Nephrology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.