Healthcare Provider Details

I. General information

NPI: 1063349892
Provider Name (Legal Business Name): WCG NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 LAFAYETTE AVE
HAWTHORNE NJ
07506-1961
US

IV. Provider business mailing address

290 LAFAYETTE AVE
HAWTHORNE NJ
07506-1961
US

V. Phone/Fax

Practice location:
  • Phone: 973-427-9200
  • Fax:
Mailing address:
  • Phone: 973-427-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SEKULEO GATHERS
Title or Position: OWNER
Credential:
Phone: 973-427-9200