Passaic Medical Walk-in and Wellness Center LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PASSAIC MEDICAL WALK-IN AND WELLNESS CENTER LLC

Doing business as

Passaic Medical & Wellness

Practice address

916 Main Ave
Passaic, NJ 07055-8545

Phone

(732) 429-7165

NPI assigned

Aug 2, 2016

Last updated

Dec 13, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark Lee

Title

Office Manager

Phone

(732) 429-7165

Specialties & licenses 1

Addresses

Other names 1

• Passaic Medical & Wellness Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alexander M Swan, MD

  • Nephrology Physician
  • Avenel, NJ
  • NPI 1346218856
  Medicare reassignment
• Shefali Kumar

  • Family Nurse Practitioner
  • Hamilton, NJ
  • NPI 1659759447
  NPD (past)

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

{
    "created_epoch": "1470096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513123200000",
    "number": "1366995896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "916 MAIN AVE",
            "address_2": "SUITE 2B",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070558545",
            "telephone_number": "732-429-7165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 MAIN AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070558545",
            "telephone_number": "732-429-7165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSAIC MEDICAL WALK-IN AND WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-02",
        "last_updated": "2017-12-13",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "732-429-7165"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Passaic Medical & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Clinic/Center in Passaic, NJ
• Providers in Passaic, NJ by specialty
• Primary Care Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.