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General NPI Number Information
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NPI Number | 1285257212
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Entity Type | Organization
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Legal Business Name | NEXGEN WELLNESS
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 231 MAIN ST UNIT 266
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City | FORT LEE
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State | NJ
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Zip | 07024-5740
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Country | US
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Telephone | 973-557-1506
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Fax | 973-954-2115
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Provider Business Mailing Address
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Address Line | 231 MAIN ST UNIT 266
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City | FORT LEE
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State | NJ
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Zip | 07024-5740
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Country | US
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Telephone | 973-557-1506
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DANIELLE ODOM
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Credential |
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Telephone | 973-557-1506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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