Provider Demographics
NPI:1881247054
Name:PRIORITY HEALTH AND WELLNESS OF MONTVALE, LLC
Entity type:Organization
Organization Name:PRIORITY HEALTH AND WELLNESS OF MONTVALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE/ SOLE MEMBER LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAPPELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-391-8600
Mailing Address - Street 1:136 SUMMIT AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1720
Mailing Address - Country:US
Mailing Address - Phone:201-391-8600
Mailing Address - Fax:201-391-8605
Practice Address - Street 1:136 SUMMIT AVE STE 102
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1720
Practice Address - Country:US
Practice Address - Phone:201-391-8600
Practice Address - Fax:201-391-8605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care