Provider Demographics
NPI:1851607329
Name:NEW LIFE HEALTH AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:NEW LIFE HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCE PRACTICE NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C
Authorized Official - Phone:973-429-4850
Mailing Address - Street 1:12 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3211
Mailing Address - Country:US
Mailing Address - Phone:973-429-4850
Mailing Address - Fax:973-429-4811
Practice Address - Street 1:12 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3211
Practice Address - Country:US
Practice Address - Phone:973-429-4850
Practice Address - Fax:973-429-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05973400363LA2200X
NJ26NN06957700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0250279Medicaid