Provider Demographics
NPI:1609001585
Name:PROVIDENCE INTEGRATIVE WELLNESS
Entity Type:Organization
Organization Name:PROVIDENCE INTEGRATIVE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GINSBERG-SELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-688-2782
Mailing Address - Street 1:182 GANO STREET
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-688-2782
Mailing Address - Fax:401-861-1055
Practice Address - Street 1:182 GANO ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-688-2782
Practice Address - Fax:401-861-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty