Provider Demographics
NPI:1679254668
Name:ONE STOP WELLNESS MD LLC
Entity Type:Organization
Organization Name:ONE STOP WELLNESS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:TIRSTAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MBC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-703-9084
Mailing Address - Street 1:51 E GARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1601
Mailing Address - Country:US
Mailing Address - Phone:386-703-9084
Mailing Address - Fax:
Practice Address - Street 1:320 CHRISTIANA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1653
Practice Address - Country:US
Practice Address - Phone:386-703-9084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty