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General NPI Number Information
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NPI Number | 1154988079
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Entity Type | Organization
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Legal Business Name | GENESIS WELLNESS MEDICAL CENTER LLC
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Dates
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Enumeration Date | 05/27/2019
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 1544 KUSER RD STE C1
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City | HAMILTON
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State | NJ
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Zip | 08619-3830
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Country | US
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Telephone | 609-585-3640
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Fax | 609-585-3620
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Provider Business Mailing Address
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Address Line | 1544 KUSER RD STE C1
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City | HAMILTON
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State | NJ
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Zip | 08619-3830
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Country | US
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Telephone | 609-585-3640
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Fax | 609-585-3620
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Authorized Official
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Title or Position | MD/MEDICAL DIRECTOR
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Name | ALFRED R TAWADROUS
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Credential |
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Telephone | 347-677-3022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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