MEDICARE: NORTH JERSEY WELLNESS CENTER

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1629552963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH JERSEY WELLNESS CENTER

Provider Business Mailing Address
First Line	:	556 ABBOTT AVE
Second Line	:
City	:	RIDGEFIELD
State	:	NJ
Zip	:	07657-2443
Country	:	US
Telephone Number	:	201-724-2261
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 KENNEDY BLVD STE 4W
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5345
Country	:	US
Telephone Number	:	201-757-3800
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. SALVADOR EMERSON REYES
Credential	:	LPC, LCADC
Telephone Number	:	201-757-3800

Provider Enumeration Date	:	09/22/2018
Last Update Date	:	11/30/2023

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