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General NPI Number Information
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NPI Number | 1245175561
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Entity Type | Organization
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Legal Business Name | BRIGHT PATH WELLNESS CENTER LLC
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 576 CENTRAL AVE STE 314
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City | EAST ORANGE
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State | NJ
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Zip | 07018-1951
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Country | US
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Telephone | 973-561-8850
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Fax | 973-561-8852
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Provider Business Mailing Address
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Address Line | 576 CENTRAL AVE STE 314
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City | EAST ORANGE
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State | NJ
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Zip | 07018-1951
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Country | US
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Telephone | 973-561-8850
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Fax | 973-561-8852
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Authorized Official
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Title or Position | OWNER
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Name | MICHEL ESTIVERNE
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Credential |
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Telephone | 973-534-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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