Healthcare Provider Details

I. General information

NPI: 1164721544
Provider Name (Legal Business Name): PATHWAY TO WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PARK AVENUE SUITE 2C 2ND FLOOR
PLAINFIELD NJ
07060
US

IV. Provider business mailing address

1010 PARK AVENUE SUITE 2C 2ND FLOOR
PLAINFIELD NJ
07060
US

V. Phone/Fax

Practice location:
  • Phone: 908-322-4800
  • Fax: 908-322-4802
Mailing address:
  • Phone: 908-322-4800
  • Fax: 908-322-4802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00167400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. VERONICA JENSEN
Title or Position: CHIEF EXECUTIVE OFFICER PSYCHIATRIC
Credential: MSN, APNC
Phone: 908-322-4800