MEDICARE: WELLNESS MANAGEMENT LLC

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	101Y00000X	Counselor	25MA07805000	NJ

General Provider Information

NPI Number	:	1558709451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	134 WALNUT ST
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-2513
Country	:	US
Telephone Number	:	973-462-0496
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 WALNUT ST
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-2513
Country	:	US
Telephone Number	:	973-462-0496
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. LILY MO
Credential	:
Telephone Number	:	973-462-0496

Provider Enumeration Date	:	06/13/2013
Last Update Date	:	06/13/2013

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