Healthcare Provider Details

I. General information

NPI: 1235211723
Provider Name (Legal Business Name): NORTHERN VIRGINIA WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 LEESBURG PIKE, STE 103
FALLS CHURCH VA
22041-3203
US

IV. Provider business mailing address

5201 LEESBURG PIKE STE 103
FALLS CHURCH VA
22041-3200
US

V. Phone/Fax

Practice location:
  • Phone: 703-933-1600
  • Fax: 703-933-2502
Mailing address:
  • Phone: 703-933-1600
  • Fax: 703-933-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0206009251
License Number StateVA

VIII. Authorized Official

Name: MR. DEEPAK NMN GOEL
Title or Position: PRESIDENT
Credential:
Phone: 703-933-1600