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General NPI Number Information
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NPI Number | 1184162133
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Entity Type | Organization
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Legal Business Name | WELLBOX NJ PC
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 01/14/2023
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Provider Practice Location Address
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Address Line | 324 SOUTH AVE E
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City | WESTFIELD
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State | NJ
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Zip | 07090-1579
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Country | US
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Telephone | 833-935-5269
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Fax |
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Provider Business Mailing Address
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Address Line | 12574 FLAGLER CENTER BLVD STE 101
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City | JACKSONVILLE
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State | FL
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Zip | 32258-2615
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Country | US
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Telephone | 949-510-2832
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | PETER WEIGEL
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Credential | MD
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Telephone | 859-905-3901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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