Healthcare Provider Details

I. General information

NPI: 1811289986
Provider Name (Legal Business Name): DURHAM NATUROPATHIC HEALTH AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MAIN ST SUITE 204
DURHAM CT
06422-2116
US

IV. Provider business mailing address

16 MAIN ST SUITE 204
DURHAM CT
06422-2116
US

V. Phone/Fax

Practice location:
  • Phone: 203-824-7428
  • Fax:
Mailing address:
  • Phone: 203-824-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000449
License Number StateCT

VIII. Authorized Official

Name: DR. JASON M BELEJACK
Title or Position: NATUROPATHIC PHYSICIAN
Credential: N.D.
Phone: 203-824-7428