Ketavita Wellness Clinic PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

KETAVITA WELLNESS CLINIC PC

Practice address

365 Franklin Ave
Wyckoff, NJ 07481-1971

Phone

(925) 565-8498

NPI assigned

Jul 16, 2025

Last updated

Oct 24, 2025By 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

Mehdi Pouria, FNPNPI 1376929042

Title

Owner

Phone

(925) 565-8498

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

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.

• Mehdi Pouria, NP

  • Family Nurse Practitioner
  • Bronx, NY
  • NPI 1376929042

  NJ

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1752624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761264000000",
    "number": "1649162439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 W WILDWOOD RD",
            "city": "SADDLE RIVER",
            "state": "NJ",
            "postal_code": "074582512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 FRANKLIN AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074811971",
            "telephone_number": "925-565-8498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETAVITA WELLNESS CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-16",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A",
        "authorized_official_last_name": "POURIA",
        "authorized_official_first_name": "MEHDI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "925-565-8498",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kathleen Galasso LCSW
• Sukhpal Kaur
• Ketarevive, Inc
• Melissa Kiel, MS
• Tina Ahn Kim, PHARMD
• Yoon-Hee Kim, PHARM.D.
• Janelle Diana King, LMT
• Lori Kitun, LCSW

• Clinic/Center in Wyckoff, NJ
• Providers in Wyckoff, NJ by specialty
• Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; 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.