Provider Demographics
NPI:1164721544
Name:PATHWAY TO WELLNESS
Entity Type:Organization
Organization Name:PATHWAY TO WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER PSYCHIATRIC
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APNC
Authorized Official - Phone:908-322-4800
Mailing Address - Street 1:1010 PARK AVENUE
Mailing Address - Street 2:SUITE 2C 2ND FLOOR
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060
Mailing Address - Country:US
Mailing Address - Phone:908-322-4800
Mailing Address - Fax:908-322-4802
Practice Address - Street 1:1010 PARK AVENUE
Practice Address - Street 2:SUITE 2C 2ND FLOOR
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060
Practice Address - Country:US
Practice Address - Phone:908-322-4800
Practice Address - Fax:908-322-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00167400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty