NPIMap

Organization Active NPI

Origin LLC

  • Multi-Specialty Clinic/Center
  • Willingboro, NJ
National Provider Identifier
1124691647
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
ORIGIN LLC
Practice address
14 Gallaway LN
Willingboro, NJ 08046-3226
Phone
(908) 494-5150
NPI assigned
Jul 22, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Leez-Betina Petit, DCNPI 1770049249
Title
Founder
Phone
(908) 494-5150

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

14 Gallaway LN
Willingboro, NJ 08046-3226

Mailing address

14 Gallaway LN
Willingboro, NJ 08046-3226

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1124691647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 GALLAWAY LN",
            "city": "WILLINGBORO",
            "state": "NJ",
            "postal_code": "080463226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 GALLAWAY LN",
            "city": "WILLINGBORO",
            "state": "NJ",
            "postal_code": "080463226",
            "telephone_number": "908-494-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORIGIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-22",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "PETIT",
        "authorized_official_first_name": "LEEZ-BETINA",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "908-494-5150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willingboro, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.