Provider Demographics
NPI:1558975789
Name:WISE HEALTH PRO
Entity Type:Organization
Organization Name:WISE HEALTH PRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMT
Authorized Official - Phone:973-506-8176
Mailing Address - Street 1:23 WHEELER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 WHEELER ST FL 2
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4603
Practice Address - Country:US
Practice Address - Phone:973-506-8176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service