Healthcare Provider Details

I. General information

NPI: 1699557652
Provider Name (Legal Business Name): WELLCARE HOLISTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MAIN ST
MATAWAN NJ
07747-2664
US

IV. Provider business mailing address

41 CENTER ST STE 106
FREEHOLD NJ
07728-2220
US

V. Phone/Fax

Practice location:
  • Phone: 973-963-4402
  • Fax: 973-363-4742
Mailing address:
  • Phone: 973-963-4402
  • Fax: 973-363-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA ELIACIN
Title or Position: NURSE PRACTITIONER
Credential: DNP
Phone: 973-963-4402