Provider Demographics
NPI:1164930152
Name:INWELLNESS CONNECTICUT LLC
Entity Type:Organization
Organization Name:INWELLNESS CONNECTICUT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:561-235-8820
Mailing Address - Street 1:417 HIGHLAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3454
Mailing Address - Country:US
Mailing Address - Phone:800-539-7175
Mailing Address - Fax:480-750-7209
Practice Address - Street 1:417 HIGHLAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3454
Practice Address - Country:US
Practice Address - Phone:800-539-7175
Practice Address - Fax:480-750-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty