Provider Demographics
NPI:1487715090
Name:THE WELLNESS CENTER
Entity type:Organization
Organization Name:THE WELLNESS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-488-4806
Mailing Address - Street 1:1214 CHAMBERS AVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3211
Mailing Address - Country:US
Mailing Address - Phone:856-488-4806
Mailing Address - Fax:856-488-4809
Practice Address - Street 1:1214 CHAMBERS AVE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3211
Practice Address - Country:US
Practice Address - Phone:856-488-4806
Practice Address - Fax:856-488-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25MB07214800103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH32980Medicare UPIN