Tristate Medical and Wellness, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

TRISTATE MEDICAL AND WELLNESS, LLC

Practice address

19 Hathaway LN
Verona, NJ 07044-2306

Phone

(917) 294-4620

NPI assigned

Oct 16, 2020

Last updated

Oct 16, 2020By 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

Dr. Jeannette Gonzalez Simon, DO

Title

Medical Director

Phone

(917) 294-4620

Specialties & licenses 1

Addresses

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.

• Jeannette Rose Gonzalez Simon, D.O.

  • Pediatric Gastroenterology Physician
  • Verona, NJ
  • NPI 1487972659
  NPD

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

{
    "created_epoch": "1602806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602806400000",
    "number": "1932707452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 HATHAWAY LN",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "070442306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 HATHAWAY LN",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "070442306",
            "telephone_number": "917-294-4620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRISTATE MEDICAL AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-16",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-16",
        "status": "A",
        "authorized_official_last_name": "SIMON",
        "authorized_official_first_name": "JEANNETTE",
        "authorized_official_middle_name": "GONZALEZ",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "917-294-4620",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura D Tobin, N.P.
• Victoria Tomasek, PH.D.
• Leisa B Tomchek
• Marta Anna Topor, PT, DPT
• Catherine A Toufiles, PSYD
• Turning Point, Inc.
• Turning Point, Inc.
• Vanguard Medical Group, PA (Town Medical Associates, P.A.)
• Vanguard Medical Group, PA
• Vanguard Partner Network LLC (New Jersey Partner Network)

• Multi-Specialty Clinic/Center in Verona, NJ
• Providers in Verona, NJ by specialty
• Multi-Specialty Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.