Healthcare Provider Details

I. General information

NPI: 1548138951
Provider Name (Legal Business Name): PURELIFE WELLNESS & MEDSPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 N WOOD AVE
LINDEN NJ
07036-4168
US

IV. Provider business mailing address

423 N WOOD AVE
LINDEN NJ
07036-4168
US

V. Phone/Fax

Practice location:
  • Phone: 908-290-0775
  • Fax:
Mailing address:
  • Phone: 908-290-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHERIN JULIANA RODRIGUEZ
Title or Position: OWNER / MANAGING MEMBER
Credential:
Phone: 732-781-6410