Provider Demographics
NPI:1558977074
Name:ZOE WELLNESS
Entity Type:Organization
Organization Name:ZOE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LUONGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-973-5017
Mailing Address - Street 1:5322 NC 55
Mailing Address - Street 2:102
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-973-5017
Mailing Address - Fax:
Practice Address - Street 1:5322 NC 55
Practice Address - Street 2:102
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-973-5017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center