Healthcare Provider Details

I. General information

NPI: 1750831020
Provider Name (Legal Business Name): SANA WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 WYOMING AVE
ELIZABETH NJ
07208-1431
US

IV. Provider business mailing address

821 WYOMING AVE
ELIZABETH NJ
07208-1431
US

V. Phone/Fax

Practice location:
  • Phone: 908-433-9380
  • Fax:
Mailing address:
  • Phone: 908-433-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00117400
License Number StateNJ

VIII. Authorized Official

Name: MARIA A BETANCOURTH
Title or Position: MANAGER
Credential: L.AC.
Phone: 908-433-9380