MEDICARE: MEDICAL CLINIC CARING INTERNATIONAL & WELLNESS CENTER 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	363LG0600X	Gerontology Nurse Practitioner

General Provider Information

NPI Number	:	1790628451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CLINIC CARING INTERNATIONAL & WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	8 JENSEN LN
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-7925
Country	:	US
Telephone Number	:	973-725-4078
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 JENSEN LN
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-7925
Country	:	US
Telephone Number	:	973-725-4078
Fax Number	:

Authorized Official
Title or Position	:	NP
Name	:	JOSE POLANCO
Credential	:	NP
Telephone Number	:	973-725-4078

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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