Provider Demographics
NPI:1932714359
Name:GREENLEAF HEALTH AND WELLNESS PC
Entity Type:Organization
Organization Name:GREENLEAF HEALTH AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENLEAF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-269-3621
Mailing Address - Street 1:PO BOX 756
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-0756
Mailing Address - Country:US
Mailing Address - Phone:480-269-3621
Mailing Address - Fax:
Practice Address - Street 1:201 CANDLEWOOD CMNS
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2169
Practice Address - Country:US
Practice Address - Phone:866-758-2357
Practice Address - Fax:732-284-3623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty