Provider Demographics
NPI:1689801284
Name:WELT, JODI MICHELE (MS, RD, PA)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:MICHELE
Last Name:WELT
Suffix:
Gender:F
Credentials:MS, RD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07504-1862
Mailing Address - Country:US
Mailing Address - Phone:973-769-2884
Mailing Address - Fax:973-278-0450
Practice Address - Street 1:750 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1353
Practice Address - Country:US
Practice Address - Phone:973-279-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1086480363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant