Provider Demographics
NPI:1477089365
Name:CLINICAL WELLNESS
Entity Type:Organization
Organization Name:CLINICAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOLTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANGOZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:570-590-7819
Mailing Address - Street 1:246 CLIFTON AVE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1900
Mailing Address - Country:US
Mailing Address - Phone:570-590-7819
Mailing Address - Fax:
Practice Address - Street 1:246 CLIFTON AVE
Practice Address - Street 2:SUITE 24
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1900
Practice Address - Country:US
Practice Address - Phone:570-590-7819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03568000405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty