NPIMap

Organization Active NPI

Sole Wellness & Aesthetics, LLC

  • Podiatrist
  • Mount Laurel, NJ
National Provider Identifier
1760916936
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
SOLE WELLNESS & AESTHETICS, LLC
Practice address
3221 Route 38 Ste 102
Mount Laurel, NJ 08054-9765
Phone
(732) 305-0891
Fax
(732) 510-5236
NPI assigned
Apr 14, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Authorized official

Name
Danial Khalifa, DPMNPI 1467899898
Title
Owner
Phone
(732) 425-7772

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
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X Primary

Addresses

Primary practice location

3221 Route 38 Ste 102
Mount Laurel, NJ 08054-9765

Mailing address

3221 Route 38 Ste 102
Mount Laurel, NJ 08054-9765

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170530000800 NJ Part B Supplier - Clinic/Group Practice 2062789894 Receives reassigned benefits from 3 practitioners
Practice locations: Princeton, NJ; Toms River, NJ; Voorhees, NJ; Whiting, NJ; Willingboro, NJ; Mount Laurel, NJ; Brick, NJ; Dayton, NJ…
O20180511000590 NJ DME Supplier - Physician - General Practice 2062789894 Practice locations: Mount Laurel, NJ

National Provider Directory

National Provider Directory

Locations

1608 Route 88 W
Ste 102
Brick, NJ 08724
Phone (732) 240-6606

1314 Hooper Ave
Ste 1
Toms River, NJ 08753
Phone (732) 425-7772

Practitioners & affiliated clinicians

Practitioners 10

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": "1492128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1760916936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 ROUTE 38 STE 102",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080549765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 ROUTE 38 STE 102",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080549765",
            "telephone_number": "732-305-0891",
            "fax_number": "732-510-5236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOLE WELLNESS & AESTHETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-14",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "KHALIFA",
        "authorized_official_first_name": "DANIAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-425-7772",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Laurel, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; 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.