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General NPI Number Information
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NPI Number | 1679191142
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Entity Type | Organization
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Legal Business Name | PA GREEN WELLNESS
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Dates
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Enumeration Date | 07/10/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 1150 FIRST AVE STE 950
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-1371
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Country | US
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Telephone | 610-909-2207
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Fax | 888-371-6433
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Provider Business Mailing Address
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Address Line | 1150 FIRST AVE STE 950
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-1371
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Country | US
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Telephone | 610-909-2207
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN CELLINI
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Credential |
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Telephone | 610-909-2207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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