Provider Demographics
NPI:1548559354
Name:WELNESS CENTER OF NORTHERN NJ
Entity Type:Organization
Organization Name:WELNESS CENTER OF NORTHERN NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MONTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-357-1555
Mailing Address - Street 1:714 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-3403
Mailing Address - Country:US
Mailing Address - Phone:973-357-1555
Mailing Address - Fax:973-357-2640
Practice Address - Street 1:714 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-3403
Practice Address - Country:US
Practice Address - Phone:973-357-1555
Practice Address - Fax:973-357-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty