1841014057 NPI number — INTEGRATIVE WELLNESS NURSE PRACTITIONER IN PSYCHIATRY LLC

Table of content: (NPI 1841014057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841014057 NPI number — INTEGRATIVE WELLNESS NURSE PRACTITIONER IN PSYCHIATRY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATIVE WELLNESS NURSE PRACTITIONER IN PSYCHIATRY LLC
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:
6
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:
1841014057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
157 E 86TH ST FL 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10028-2175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CARNEGIE CTR STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-6285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-790-4511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCBRIDE
Authorized Official First Name:
CLAUDIA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE ASSOCIATE
Authorized Official Telephone Number:
225-235-4984

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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