Provider Demographics
NPI:1558709451
Name:WELLNESS MANAGEMENT LLC
Entity Type:Organization
Organization Name:WELLNESS MANAGEMENT LLC
Other - Org Name:MARC CANTILLON MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:MO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-462-0496
Mailing Address - Street 1:134 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2513
Mailing Address - Country:US
Mailing Address - Phone:973-462-0496
Mailing Address - Fax:
Practice Address - Street 1:134 WALNUT ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2513
Practice Address - Country:US
Practice Address - Phone:973-462-0496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07805000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091086Medicare UPIN