Provider Demographics
NPI:1114558780
Name:GREENBOOK HEALTH & WELLNESS
Entity Type:Organization
Organization Name:GREENBOOK HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:OGBONNAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:UKPAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-512-8724
Mailing Address - Street 1:169 IVY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-2843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:169 IVY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-2843
Practice Address - Country:US
Practice Address - Phone:973-475-5337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty