Provider Demographics
NPI:1407409360
Name:MORDECAI & CARAVELLO WELLNESS, LLC
Entity Type:Organization
Organization Name:MORDECAI & CARAVELLO WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARAVELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-932-5299
Mailing Address - Street 1:14 MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8181
Mailing Address - Country:US
Mailing Address - Phone:609-932-5299
Mailing Address - Fax:
Practice Address - Street 1:1401 MARLTON PIKE E STE 14
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2207
Practice Address - Country:US
Practice Address - Phone:609-932-5299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty