Healthcare Provider Details

I. General information

NPI: 1033708698
Provider Name (Legal Business Name): BEACON HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MONTGOMERY ST STE 2
JERSEY CITY NJ
07302-5052
US

IV. Provider business mailing address

89 CENTRAL AVE
JERSEY CITY NJ
07306-2124
US

V. Phone/Fax

Practice location:
  • Phone: 201-776-8610
  • Fax:
Mailing address:
  • Phone: 201-776-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK ERNESTO DIGENOVA
Title or Position: FOUNDER
Credential: MD
Phone: 201-776-8610