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General NPI Number Information
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NPI Number | 1477089365
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Entity Type | Organization
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Legal Business Name | CLINICAL WELLNESS
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 246 CLIFTON AVE SUITE 24
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City | CLIFTON
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State | NJ
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Zip | 07011-1900
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Country | US
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Telephone | 570-590-7819
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Fax |
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Provider Business Mailing Address
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Address Line | 246 CLIFTON AVE SUITE 24
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City | CLIFTON
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State | NJ
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Zip | 07011-1900
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Country | US
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Telephone | 570-590-7819
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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. SOLTAN CANGOZ
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Credential | PHARMD
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Telephone | 570-590-7819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 28RI03568000
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License Number State | NJ
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