Provider Demographics
NPI:1629648100
Name:PLAZA HEALTH AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:PLAZA HEALTH AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BATARSEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-797-2003
Mailing Address - Street 1:6-20 PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3113
Mailing Address - Country:US
Mailing Address - Phone:201-797-2003
Mailing Address - Fax:
Practice Address - Street 1:6-20 PLAZA RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3113
Practice Address - Country:US
Practice Address - Phone:201-797-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty