Provider Demographics
NPI:1366742868
Name:EMBRACE PSYCHIATRIC WELLNESS CENTER
Entity type:Organization
Organization Name:EMBRACE PSYCHIATRIC WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEOPOLD
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:BOLONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-233-8065
Mailing Address - Street 1:354 SOUTH AVE E
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1788
Mailing Address - Country:US
Mailing Address - Phone:908-233-8065
Mailing Address - Fax:908-233-8042
Practice Address - Street 1:354 SOUTH AVE E
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1788
Practice Address - Country:US
Practice Address - Phone:908-233-8065
Practice Address - Fax:908-233-8042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEOPOLD J BOLONA MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-30
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA087021002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty