Provider Demographics
NPI:1457045320
Name:NOVA PAX WELLNESS LLC
Entity Type:Organization
Organization Name:NOVA PAX WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTSFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:BCDFM
Authorized Official - Phone:949-289-1273
Mailing Address - Street 1:1208 JACKSONVILLE SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-4009
Mailing Address - Country:US
Mailing Address - Phone:949-289-1273
Mailing Address - Fax:
Practice Address - Street 1:501 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:ROEBLING
Practice Address - State:NJ
Practice Address - Zip Code:08554-1904
Practice Address - Country:US
Practice Address - Phone:949-289-1273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty