Healthcare Provider Details

I. General information

NPI: 1275161960
Provider Name (Legal Business Name): ZION WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 WEST ZION ROAD UNIT 110
SALISBURY MD
21801
US

IV. Provider business mailing address

2324 WEST ZION ROAD UNIT 110
SALISBURY MD
21801
US

V. Phone/Fax

Practice location:
  • Phone: 443-978-7316
  • Fax:
Mailing address:
  • Phone: 443-978-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANJULA BORGE
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 443-978-7316