Provider Demographics
NPI:1417095902
Name:NEW GARDEN MEDICAL AND WELLNESS CENTER
Entity Type:Organization
Organization Name:NEW GARDEN MEDICAL AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ORAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-444-1424
Mailing Address - Street 1:747 W CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2463
Mailing Address - Country:US
Mailing Address - Phone:610-444-1424
Mailing Address - Fax:610-444-1103
Practice Address - Street 1:747 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2463
Practice Address - Country:US
Practice Address - Phone:610-444-1424
Practice Address - Fax:610-444-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007105Medicare ID - Type Unspecified