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General NPI Number Information
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NPI Number | 1245005669
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Entity Type | Organization
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Legal Business Name | NISSI IV HYDRATION THERAPY AND WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 15 W PROSPECT ST STE 3
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-2161
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Country | US
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Telephone | 732-301-4465
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Fax | 732-301-4492
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Provider Business Mailing Address
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Address Line | 15 W PROSPECT STREET SUITE 3
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-8578
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Country | US
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Telephone | 732-301-4465
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Fax |
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Authorized Official
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Title or Position | OWNER,ADMINISTRATOR
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Name | AMANDA ADIYIA
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Credential | FNP
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Telephone | 732-301-4465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 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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