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NPI Code Detail

MEDICARE: EMBRACE PSYCHIATRIC WELLNESS CENTER

MEDICARE: EMBRACE PSYCHIATRIC WELLNESS CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician25MA08702100NJ

General Provider Information

NPI Number : 1366742868
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMBRACE PSYCHIATRIC WELLNESS CENTER
Provider Business Mailing Address
First Line : 354 SOUTH AVE E
Second Line :
City : WESTFIELD
State : NJ
Zip : 07090-1788
Country : US
Telephone Number : 908-233-8065
Fax Number : 908-233-8042
Provider Business Practice Location Address
First Line : 354 SOUTH AVE E
Second Line :
City : WESTFIELD
State : NJ
Zip : 07090-1788
Country : US
Telephone Number : 908-233-8065
Fax Number : 908-233-8042
Authorized Official
Title or Position : OWNER
Name : DR. LEOPOLD JORGE BOLONA
Credential : M.D.
Telephone Number : 908-233-8065
Provider Enumeration Date : 10/30/2010
Last Update Date : 05/24/2022

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Directions to “EMBRACE PSYCHIATRIC WELLNESS CENTER ” Practice Location

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