Provider Demographics
NPI:1104835271
Name:MOBILE WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:MOBILE WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANSAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-214-9212
Mailing Address - Street 1:711 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3003
Mailing Address - Country:US
Mailing Address - Phone:888-214-9212
Mailing Address - Fax:888-214-9212
Practice Address - Street 1:711 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3003
Practice Address - Country:US
Practice Address - Phone:888-214-9212
Practice Address - Fax:888-214-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07696500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084650Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER