NPIMap

Organization Active NPI

Genesis Wellness Medical Center LLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Hamilton, NJ
National Provider Identifier
1154988079
Registry record updated Apr 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
Legal business name
GENESIS WELLNESS MEDICAL CENTER LLC
Practice address
1544 Kuser Rd Ste C1
Hamilton, NJ 08619-3830
Phone
(609) 585-3640
Fax
(609) 585-3620
NPI assigned
May 27, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2020

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

Authorized official

Name
Alfred R Tawadrous
Title
MD/Medical Director
Phone
(347) 677-3022

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

1544 Kuser Rd Ste C1
Hamilton, NJ 08619-3830

Mailing address

1544 Kuser Rd Ste C1
Hamilton, NJ 08619-3830
Phone (609) 585-3640

Other practice location 1

901 Route 73 N Ste C
Marlton, NJ 08053-2034
Phone (856) 581-9711

Other identifiers 1

IdentifierTypeStateIssuer
0447366MedicaidNJ

National Provider Directory

National Provider Directory

Locations

975 Route 73 N
Ste B
Marlton, NJ 08053
Phone (609) 495-2522

Practitioners & affiliated clinicians

Practitioners 11

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": "1558915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586131200000",
    "number": "1154988079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1544 KUSER RD STE C1",
            "city": "HAMILTON",
            "state": "NJ",
            "postal_code": "086193830",
            "telephone_number": "609-585-3640",
            "fax_number": "609-585-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1544 KUSER RD STE C1",
            "city": "HAMILTON",
            "state": "NJ",
            "postal_code": "086193830",
            "telephone_number": "609-585-3640",
            "fax_number": "609-585-3620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "901 Route 73 N Ste C",
            "address_purpose": "LOCATION",
            "city": "Marlton",
            "state": "NJ",
            "postal_code": "080532034",
            "country_code": "US",
            "telephone_number": "856-581-9711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GENESIS WELLNESS MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-27",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A",
        "authorized_official_last_name": "TAWADROUS",
        "authorized_official_first_name": "ALFRED",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MD/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "347-677-3022"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0447366",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamilton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; 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.