Healthcare Provider Details

I. General information

NPI: 1851607329
Provider Name (Legal Business Name): NEW LIFE HEALTH AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 PROSPECT ST
BLOOMFIELD NJ
07003-3211
US

IV. Provider business mailing address

12 PROSPECT ST
BLOOMFIELD NJ
07003-3211
US

V. Phone/Fax

Practice location:
  • Phone: 973-429-4850
  • Fax: 973-429-4811
Mailing address:
  • Phone: 973-429-4850
  • Fax: 973-429-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN05973400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NN06957700
License Number StateNJ

VIII. Authorized Official

Name: MS. JOANNE WEBB-WILLIAMS
Title or Position: ADVANCE PRACTICE NURSE
Credential: APN-C
Phone: 973-429-4850