REVERSE TIME WELLNESS INC NPI 1003611187

NPI Information

  • NPI: 1003611187
  • Provider Name: REVERSE TIME WELLNESS INC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 07D2320774
  • Address: 1086 LONG RIDGE RD
    STAMFORD, CT
    ZIP 06903
  • Phone: (203) 274-7426

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NPI Details

REVERSE TIME WELLNESS INC is a family medicine in Stamford, CT. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. REVERSE TIME WELLNESS INC NPI is 1003611187. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1086 LONG RIDGE RD
STAMFORD, CT
ZIP 06903-404
Phone: (203) 274-7426
Fax: (203) 274-7426

The provider's authorized official is Neishelle Walcott .
The authorized official title is President and has the following contact phone number (203) 274-7426.

The CLIA number assigned to this NPI record is 07D2320774 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/13/2025 and was last updated on 4/8/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207PE0004XEmergency MedicineEmergency Medical ServicesNo
2207Q00000XFamily MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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