Healthcare Provider Details

I. General information

NPI: 1447923370
Provider Name (Legal Business Name): METRO HEALTH & WELLNESS CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 KENNEDY BLVD
JERSEY CITY NJ
07306-5507
US

IV. Provider business mailing address

2755 KENNEDY BLVD
JERSEY CITY NJ
07306-5507
US

V. Phone/Fax

Practice location:
  • Phone: 646-477-5862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SURAJ DEVESAR
Title or Position: CEO
Credential:
Phone: 646-477-5862