Provider Demographics
NPI:1033708698
Name:BEACON HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:BEACON HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:DIGENOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-776-8610
Mailing Address - Street 1:89 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2124
Mailing Address - Country:US
Mailing Address - Phone:201-776-8610
Mailing Address - Fax:
Practice Address - Street 1:201 MONTGOMERY ST STE 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5052
Practice Address - Country:US
Practice Address - Phone:201-776-8610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty