Provider Demographics
NPI:1619471067
Name:WELLNESS SUITE 360,P.C
Entity Type:Organization
Organization Name:WELLNESS SUITE 360,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAT-FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-337-8041
Mailing Address - Street 1:10 EARLIN AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015-1745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 EARLIN AVE STE 290
Practice Address - Street 2:
Practice Address - City:BROWNS MILLS
Practice Address - State:NJ
Practice Address - Zip Code:08015-1745
Practice Address - Country:US
Practice Address - Phone:908-337-8041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty