Healthcare Provider Details

I. General information

NPI: 1780931188
Provider Name (Legal Business Name): PRIORITY HEALTH AND WELLNESS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 VALLEY RD
WAYNE NJ
07470-2900
US

IV. Provider business mailing address

930 VALLEY RD
WAYNE NJ
07470-2900
US

V. Phone/Fax

Practice location:
  • Phone: 973-696-3868
  • Fax: 800-507-4594
Mailing address:
  • Phone: 973-696-3868
  • Fax: 800-507-4594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number0400492155
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number0400492155
License Number StateNJ

VIII. Authorized Official

Name: DR. ANTONIO ANGELITO
Title or Position: OWNER
Credential: DNP, APN,C
Phone: 973-696-3868