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General NPI Number Information
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NPI Number | 1619855442
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Entity Type | Organization
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Legal Business Name | CHAVIV TRT & WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 750 ROUTE 73 S STE 205
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City | MARLTON
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State | NJ
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Zip | 08053-4133
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Country | US
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Telephone | 609-507-1939
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Fax |
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Provider Business Mailing Address
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Address Line | 44 BERNARD DR
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City | EWING
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State | NJ
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Zip | 08628-2301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | VIVIAN OWUSU-MENSAH
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Credential | DNP, APN
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Telephone | 973-902-8484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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