Provider Demographics
NPI:1629552963
Name:NORTH JERSEY WELLNESS CENTER
Entity Type:Organization
Organization Name:NORTH JERSEY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:EMERSON
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC
Authorized Official - Phone:201-757-3800
Mailing Address - Street 1:556 ABBOTT AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2443
Mailing Address - Country:US
Mailing Address - Phone:201-724-2261
Mailing Address - Fax:
Practice Address - Street 1:8901 KENNEDY BLVD STE 4W
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5345
Practice Address - Country:US
Practice Address - Phone:201-757-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-22
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty