Provider Demographics
NPI:1821248956
Name:THE ROCK WELLNESS CENTER PC
Entity Type:Organization
Organization Name:THE ROCK WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AJEEB
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-821-0203
Mailing Address - Street 1:2591 BAGLYOS CIR
Mailing Address - Street 2:SUITE C-50
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8027
Mailing Address - Country:US
Mailing Address - Phone:484-821-0203
Mailing Address - Fax:484-821-0214
Practice Address - Street 1:2591 BAGLYOS CIR
Practice Address - Street 2:SUITE C-50
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8027
Practice Address - Country:US
Practice Address - Phone:484-821-0203
Practice Address - Fax:484-821-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068349L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00323966OtherMEDICARE RAILROAD
NJ0057886Medicaid
PAP00323966OtherMEDICARE RAILROAD
NJ0057886Medicaid