Provider Demographics
NPI:1275063679
Name:HEALTH-WISE FAMILY CARE CENTER LLC
Entity Type:Organization
Organization Name:HEALTH-WISE FAMILY CARE CENTER LLC
Other - Org Name:HEALTH-WISE FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN/ED FNP-BC
Authorized Official - Phone:908-432-7864
Mailing Address - Street 1:1 RUNYON AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4612
Mailing Address - Country:US
Mailing Address - Phone:908-432-7864
Mailing Address - Fax:
Practice Address - Street 1:400 W FRONT ST OFC 2
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1120
Practice Address - Country:US
Practice Address - Phone:908-432-7864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00702000261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care