Provider Demographics
NPI:1386027266
Name:BROADWAY WELLNESS, P.C.
Entity Type:Organization
Organization Name:BROADWAY WELLNESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-771-3100
Mailing Address - Street 1:1 BROADWAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1842
Mailing Address - Country:US
Mailing Address - Phone:201-771-3100
Mailing Address - Fax:201-397-1797
Practice Address - Street 1:1 BROADWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1842
Practice Address - Country:US
Practice Address - Phone:201-771-3100
Practice Address - Fax:201-397-1797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty