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General NPI Number Information
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NPI Number | 1811798804
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Entity Type | Organization
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Legal Business Name | OPTIMIZED WELLNESS
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 140 BAY ST
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City | JERSEY CITY
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State | NJ
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Zip | 07302-5909
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Country | US
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Telephone | 201-533-9883
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Fax | 201-633-2771
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Provider Business Mailing Address
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Address Line | 140 BAY ST
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City | JERSEY CITY
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State | NJ
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Zip | 07302-5909
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Country | US
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Telephone | 201-533-9883
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Fax | 201-633-2760
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Authorized Official
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Title or Position | COO
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Name | MR. VICTOR CHU
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Credential |
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Telephone | 732-939-0839
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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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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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