Provider Demographics
NPI:1881465128
Name:TIKVAH INTEGRATED MENTAL HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:TIKVAH INTEGRATED MENTAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:H
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-896-9421
Mailing Address - Street 1:55 ROUTE 70 E STE 3
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1769
Mailing Address - Country:US
Mailing Address - Phone:908-782-1300
Mailing Address - Fax:908-548-9544
Practice Address - Street 1:55 ROUTE 70 E STE 3
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1769
Practice Address - Country:US
Practice Address - Phone:908-782-1300
Practice Address - Fax:908-548-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty