Healthcare Provider Details

I. General information

NPI: 1932714359
Provider Name (Legal Business Name): GREENLEAF HEALTH AND WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CANDLEWOOD CMNS
HOWELL NJ
07731-2169
US

IV. Provider business mailing address

PO BOX 756
CLARKSBURG NJ
08510-0756
US

V. Phone/Fax

Practice location:
  • Phone: 866-758-2357
  • Fax: 732-284-3623
Mailing address:
  • Phone: 480-269-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: BETSY GREENLEAF
Title or Position: CEO
Credential: DO
Phone: 480-269-3621