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General NPI Number Information
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NPI Number | 1144786732
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Entity Type | Organization
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Legal Business Name | PURE WELLNESS MEDICAL PLLC
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 199 WASHINGTON ST
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City | NORTHVALE
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State | NJ
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Zip | 07647-2118
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Country | US
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Telephone | 855-679-7873
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Fax | 855-679-7873
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Provider Business Mailing Address
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Address Line | 22 BYRNE PL
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City | BERGENFIELD
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State | NJ
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Zip | 07621-1002
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Country | US
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Telephone | 347-585-0208
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Fax |
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. DAVID PETER SUAREZ
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Credential | DO
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Telephone | 855-679-7873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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