Healthcare Provider Details

I. General information

NPI: 1073918504
Provider Name (Legal Business Name): ANEW WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 DAVIDSON AVENUE SUITE 105
SOMERSET NJ
08873-4140
US

IV. Provider business mailing address

270 DAVIDSON AVENUE SUITE 105
SOMERSET NJ
08873-4140
US

V. Phone/Fax

Practice location:
  • Phone: 732-328-2639
  • Fax: 800-878-9212
Mailing address:
  • Phone: 732-328-2639
  • Fax: 800-878-9212

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: MR. JEROME K MITCHELL
Title or Position: CEO
Credential: ESQ.
Phone: 732-328-2639