MEDICARE: COMMUNITY FAMILY HEALTH AND WELLNESS CENTER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ00076500	NJ

General Provider Information

NPI Number	:	1184668493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY FAMILY HEALTH AND WELLNESS CENTER INC.

Provider Business Mailing Address
First Line	:	909 RINGWOOD AVE
Second Line	:
City	:	HASKELL
State	:	NJ
Zip	:	07420-1343
Country	:	US
Telephone Number	:	973-831-6700
Fax Number	:	973-831-6703

Provider Business Practice Location Address
First Line	:	909 RINGWOOD AVE
Second Line	:
City	:	HASKELL
State	:	NJ
Zip	:	07420-1343
Country	:	US
Telephone Number	:	973-831-6700
Fax Number	:	973-831-6703

Authorized Official
Title or Position	:	SECRATERY
Name	:	DR. NICHOLAS VINCENT CAMPANELLA
Credential	:	MD
Telephone Number	:	973-831-6700

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/22/2020

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