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21st Century Total Health Clinic PC

Exclusive Provider Organization in Orange, NJ. Organization (NPI-2).

NPI number1679909030
StatusActive
Last updated in NPPESAug 4, 2016

Details

NPI
1679909030
Entity type
Organization (NPI-2)
Legal business name
21st Century Total Health Clinic PC
Organization subpart
No
Enumeration date
Sep 17, 2013
Last updated
Aug 4, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
302F00000X Exclusive Provider Organization38mcoo641500NJYes

Practice location

439 Main St
Suite 101
Orange, NJ 07050-1523

Phone 973-675-8700 · Fax 973-675-8701

Mailing address

439 Main St
Suite 101
Orange, NJ 07050-1523

Phone 973-675-8700 · Fax 973-675-8701

Authorized official

Kesnold Baptiste
President
9086257463

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