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General NPI Number Information
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NPI Number | 1366742868
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Entity Type | Organization
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Legal Business Name | EMBRACE PSYCHIATRIC WELLNESS CENTER
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Dates
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Enumeration Date | 10/30/2010
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 354 SOUTH AVE E
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City | WESTFIELD
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State | NJ
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Zip | 07090-1788
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Country | US
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Telephone | 908-233-8065
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Fax | 908-233-8042
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Provider Business Mailing Address
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Address Line | 354 SOUTH AVE E
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City | WESTFIELD
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State | NJ
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Zip | 07090-1788
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Country | US
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Telephone | 908-233-8065
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Fax | 908-233-8042
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEOPOLD JORGE BOLONA
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Credential | M.D.
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Telephone | 908-233-8065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA08702100
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License Number State | NJ
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