Ketamine Wellness Infusions PA LLC

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Legal business name

KETAMINE WELLNESS INFUSIONS PA LLC

Practice address

146 Montgomery Ave Ste 202
Bala Cynwyd, PA 19004-2956

Phone

(484) 434-9633

NPI assigned

Jan 30, 2024

Organization subpart

No

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

Authorized official

Name

Jill Gabay

Title

Medical Director

Phone

(484) 434-8963

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1706572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710201600000",
    "number": "1629830005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 MONTGOMERY AVE STE 202",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190042956",
            "telephone_number": "484-434-8963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 MONTGOMERY AVE STE 202",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190042956",
            "telephone_number": "484-434-9633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAMINE WELLNESS INFUSIONS PA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A",
        "authorized_official_last_name": "GABAY",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "484-434-8963"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine Kazanjian, CRNP
• Pamela N. Kelberg
• Jennifer Kelly
• Sarah Kelly, AUD
• Joseph S Kenney III, D.O.
• Anika Nurin Khan, PHD
• Meher S Khan, MD
• Tarik Sharif Khan, FNP
• Mohammed Shoaib Jameel Kidwai, MD
• Timothy Kim, OD

• Certified Registered Nurse Anesthetist in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• Certified Registered Nurse Anesthetist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; 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.