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General NPI Number Information
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NPI Number | 1487715090
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Entity Type | Organization
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Legal Business Name | THE WELLNESS CENTER
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1214 CHAMBERS AVE
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City | CHERRY HILL
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State | NJ
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Zip | 08002-3211
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Country | US
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Telephone | 856-488-4806
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Fax | 856-488-4809
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Provider Business Mailing Address
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Address Line | 1214 CHAMBERS AVE
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City | CHERRY HILL
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State | NJ
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Zip | 08002-3211
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Country | US
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Telephone | 856-488-4806
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Fax | 856-488-4809
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Authorized Official
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Title or Position | NEUROLOGY
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Name | DR. SEAN T HUBBARD
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Credential | D.O
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Telephone | 856-488-4806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 25MB07214800
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License Number State | NY
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