Healthcare Provider Details

I. General information

NPI: 1154760841
Provider Name (Legal Business Name): DO WELL BE WELL OF HASKELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 RINGWOOD AVE SUITE 7
HASKELL NJ
07420-1565
US

IV. Provider business mailing address

1141 RINGWOOD AVE SUITE 7
HASKELL NJ
07420-1565
US

V. Phone/Fax

Practice location:
  • Phone: 973-831-2880
  • Fax: 862-248-0528
Mailing address:
  • Phone: 973-831-2880
  • Fax: 862-248-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KEVIN HALL
Title or Position: OWNER
Credential: MD
Phone: 973-831-2880