Provider Demographics
NPI:1245047786
Name:CT MEDICAL AND WELLNESS
Entity type:Organization
Organization Name:CT MEDICAL AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CARMELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-341-8604
Mailing Address - Street 1:61 BOGERT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2905
Mailing Address - Country:US
Mailing Address - Phone:201-341-8604
Mailing Address - Fax:
Practice Address - Street 1:250 MADISON AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07524-1814
Practice Address - Country:US
Practice Address - Phone:973-956-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA067115OtherNJ STATE MEDICAL LICENCSE