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General NPI Number Information
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NPI Number | 1710304274
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Entity Type | Organization
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Legal Business Name | PRIMEHEALTH & WELLNESS CENTER
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Dates
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Enumeration Date | 03/22/2014
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Last Update Date | 03/22/2014
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Provider Practice Location Address
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Address Line | 85 RARITAN AVE STE 460
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City | HIGHLAND PARK
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State | NJ
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Zip | 08904-2439
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Country | US
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Telephone | 845-406-1985
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Fax |
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Provider Business Mailing Address
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Address Line | 85 RARITAN AVE STE 460
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City | HIGHLAND PARK
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State | NJ
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Zip | 08904-2439
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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 | MEMBER/MANAGER
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Name | JERRY CHOI
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Credential | DPT
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Telephone | 845-406-1985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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