Provider Demographics
NPI:1518435007
Name:PHYSICIAN HEALTH AND WELLNESS
Entity type:Organization
Organization Name:PHYSICIAN HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JO-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKARJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-471-2109
Mailing Address - Street 1:700 AVENUE C STE 1
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5837
Mailing Address - Country:US
Mailing Address - Phone:201-230-6637
Mailing Address - Fax:
Practice Address - Street 1:2106 NEW RD STE E2
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1052
Practice Address - Country:US
Practice Address - Phone:201-230-6637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care