Provider Demographics
NPI:1780931188
Name:PRIORITY HEALTH AND WELLNESS CARE LLC
Entity type:Organization
Organization Name:PRIORITY HEALTH AND WELLNESS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELITO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN,C
Authorized Official - Phone:973-696-3868
Mailing Address - Street 1:930 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2900
Mailing Address - Country:US
Mailing Address - Phone:973-696-3868
Mailing Address - Fax:800-507-4594
Practice Address - Street 1:930 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2900
Practice Address - Country:US
Practice Address - Phone:973-696-3868
Practice Address - Fax:800-507-4594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400492155261QU0200X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ173636OtherMEDICARE PTAN
NJ0228559Medicaid
NJ173636OtherMEDICARE PTAN