Provider Demographics
NPI:1245646371
Name:MONROE WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:MONROE WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-338-7860
Mailing Address - Street 1:7 CENTRE DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1565
Mailing Address - Country:US
Mailing Address - Phone:631-338-7860
Mailing Address - Fax:
Practice Address - Street 1:7 CENTRE DR
Practice Address - Street 2:SUITE 10
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-1565
Practice Address - Country:US
Practice Address - Phone:609-662-4714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ460385Medicare UPIN