=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841911559
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPOTSWOOD WELLNESS CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2022
-----------------------------------------------------
Last Update Date | 08/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 SNOWHILL ST
-----------------------------------------------------
City | SPOTSWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08884-1358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-955-6060
-----------------------------------------------------
Fax | 732-210-4821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 SNOWHILL ST
-----------------------------------------------------
City | SPOTSWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08884-1358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-955-6060
-----------------------------------------------------
Fax | 732-210-4821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | MOHAMED-AMR HILLAL
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 908-616-2889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------