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General NPI Number Information
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NPI Number | 1407409360
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Entity Type | Organization
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Legal Business Name | MORDECAI & CARAVELLO WELLNESS, LLC
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 1401 MARLTON PIKE E STE 14
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City | CHERRY HILL
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State | NJ
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Zip | 08034-2207
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Country | US
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Telephone | 609-932-5299
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Fax |
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Provider Business Mailing Address
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Address Line | 14 MAGNOLIA CT
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City | MEDFORD
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State | NJ
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Zip | 08055-8181
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Country | US
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Telephone | 609-932-5299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW B CARAVELLO
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Credential | DO
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Telephone | 609-932-5299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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