1750709887 NPI number — JASENG WELLNESS CORPORATION

Table of content: DEBRA LYNN WILSON DODD (NPI 1720683014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750709887 NPI number — JASENG WELLNESS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JASENG WELLNESS CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750709887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 SYLVAN AVE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
ENGLEWOOD CLIFFS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07632-2724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-227-8275
Provider Business Mailing Address Fax Number:
714-870-5028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 SYLVAN AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
ENGLEWOOD CLIFFS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07632-2724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-227-8275
Provider Business Practice Location Address Fax Number:
714-870-5028
Provider Enumeration Date:
04/05/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-313-4664

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)