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General NPI Number Information
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NPI Number | 1710833348
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Entity Type | Organization
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Legal Business Name | THE KEANSBURG WELLNESS CENTER PE LLC
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 204 MAIN ST
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City | KEANSBURG
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State | NJ
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Zip | 07734-1735
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Country | US
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Telephone | 732-495-1474
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Fax | 718-679-9285
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Provider Business Mailing Address
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Address Line | 233 GIFFORDS LN
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City | STATEN ISLAND
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State | NY
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Zip | 10308-2044
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Country | US
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Telephone | 732-495-1474
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Fax | 718-679-9285
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MRS. DENISE CAMMARATA
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Credential |
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Telephone | 646-421-3566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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