Provider Demographics
NPI:1639415110
Name:RUTGERS FOCUS WELLNESS CENTER
Entity Type:Organization
Organization Name:RUTGERS FOCUS WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN AND PROFESSOR RUTGERS COLLEGE
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLZEMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN PHD FAAN
Authorized Official - Phone:973-732-6040
Mailing Address - Street 1:449 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-3224
Mailing Address - Country:US
Mailing Address - Phone:973-732-6040
Mailing Address - Fax:973-353-1035
Practice Address - Street 1:449 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-3224
Practice Address - Country:US
Practice Address - Phone:973-732-6040
Practice Address - Fax:973-353-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty