Provider Demographics
NPI:1528541208
Name:OSTEOPATHIC WELLNESS OF NEW JERSEY, LLC
Entity Type:Organization
Organization Name:OSTEOPATHIC WELLNESS OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUMIE
Authorized Official - Middle Name:NISHIDA
Authorized Official - Last Name:BURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-345-0772
Mailing Address - Street 1:88 W RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3199
Mailing Address - Country:US
Mailing Address - Phone:201-345-0772
Mailing Address - Fax:
Practice Address - Street 1:88 W RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3199
Practice Address - Country:US
Practice Address - Phone:201-345-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service