Wellcare Tccm
Internal Medicine in Hackensack, NJ. Organization (NPI-2).
NPI number1982245932
StatusActive
Last updated in NPPESOct 22, 2019
Details
- NPI
- 1982245932
- Entity type
- Organization (NPI-2)
- Legal business name
- Wellcare Tccm
- Organization subpart
- No
- Enumeration date
- Oct 1, 2019
- Last updated
- Oct 22, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
Practice location
250 Moore StHackensack, NJ 07601-7506
Phone 201-686-8734
Mailing address
250 Moore StHackensack, NJ 07601-7506
Phone 201-686-8734
Authorized official
Kaitlyn Gomez
Owner
2016868734
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