MEDICARE: WELLCARE OF NEW JERSEY, 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	332B00000X	Durable Medical Equipment & Medical Supplies	3000007639	PA
2	332B00000X	Durable Medical Equipment & Medical Supplies		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427039379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLCARE OF NEW JERSEY, INC.

Provider Business Mailing Address
First Line	:	410 GARIBALDI AVE
Second Line	:	UNIT B
City	:	LODI
State	:	NJ
Zip	:	07644-3710
Country	:	US
Telephone Number	:	973-777-3196
Fax Number	:	973-777-3195

Provider Business Practice Location Address
First Line	:	410 GARIBALDI AVE
Second Line	:	UNIT B
City	:	LODI
State	:	NJ
Zip	:	07644-3710
Country	:	US
Telephone Number	:	973-777-3196
Fax Number	:	973-777-3195

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DANIEL JACKSON
Credential	:
Telephone Number	:	973-777-3196

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/21/2022

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