CLASSIC WELLNESS FAMILY MEDICAL PRACTICE LLC NPI 1376950279

NPI Information

NPI: 1376950279
Provider Name: CLASSIC WELLNESS FAMILY MEDICAL PRACTICE LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
1220 VICTOR AVE
UNION, NJ
ZIP 07083
Phone: (718) 753-1721
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CLASSIC WELLNESS FAMILY MEDICAL PRACTICE LLC is a primary care clinic center in Union, NJ. CLASSIC WELLNESS FAMILY MEDICAL PRACTICE LLC NPI is 1376950279. The provider is registered as an organization entity type.

The provider's business location address is:

1220 VICTOR AVE
UNION, NJ
ZIP 07083-706
Phone: (718) 753-1721

The provider's authorized official is Daniel D Okoro .
The authorized official title is Doctor Of Nursing Practice, Apn and has the following contact phone number (718) 753-1721.

The enumeration date for this NPI number is 7/14/2014 and was last updated on 4/27/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP3300X	Clinic/Center	Pain	26NJ00257300	NEW JERSEY	No
2	207Q00000X	Family Medicine		26NJ00257300	NEW JERSEY	No
3	208D00000X	General Practice		26NJ00257300	NEW JERSEY	No
4	261QP2300X	Clinic/Center	Primary Care	26NJ00257300	NEW JERSEY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0453951	MEDICAID	NEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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