Provider Demographics
NPI:1225229321
Name:WELLNESS GROUP OF NEW JERSEY
Entity Type:Organization
Organization Name:WELLNESS GROUP OF NEW JERSEY
Other - Org Name:SUZANNE DRAKE, PHD, APRN, BC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, APRN
Authorized Official - Phone:908-625-2128
Mailing Address - Street 1:1100 RAHWAY RD
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-3412
Mailing Address - Country:US
Mailing Address - Phone:908-625-2128
Mailing Address - Fax:908-754-5907
Practice Address - Street 1:400D LAKE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1279
Practice Address - Country:US
Practice Address - Phone:908-625-2128
Practice Address - Fax:908-754-5907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty