Basic Information
| Provider Information | |||||||||
| NPI: | 1639415110 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RUTGERS FOCUS WELLNESS CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 449 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071023224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737326040 | ||||||||
| FaxNumber: | 9733531035 | ||||||||
| Practice Location | |||||||||
| Address1: | 449 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071023224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737326040 | ||||||||
| FaxNumber: | 9733531035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2013 | ||||||||
| LastUpdateDate: | 01/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | HOLZEMER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DEAN AND PROFESSOR RUTGERS COLLEGE | ||||||||
| AuthorizedOfficialTelephone: | 9737326040 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN PHD FAAN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.