Healthcare Provider Details

I. General information

NPI: 1518620830
Provider Name (Legal Business Name): COMPLETE MEDICAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 ELMORA AVE STE 243
ELIZABETH NJ
07202-1148
US

IV. Provider business mailing address

PO BOX 103
HILLSDALE NJ
07642-0103
US

V. Phone/Fax

Practice location:
  • Phone: 201-263-1771
  • Fax: 844-243-8021
Mailing address:
  • Phone: 201-263-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROXANA RITO
Title or Position: OWNER
Credential:
Phone: 201-522-3205