Healthcare Provider Details

I. General information

NPI: 1609641083
Provider Name (Legal Business Name): INNERWAVE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 VALLEY RD STE 1
MONTCLAIR NJ
07042-2709
US

IV. Provider business mailing address

28 VALLEY RD STE 1
MONTCLAIR NJ
07042-2709
US

V. Phone/Fax

Practice location:
  • Phone: 201-565-0979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LING CHEN
Title or Position: NURSE PRACTITIONER
Credential: APN
Phone: 201-565-0979