Inner Wellth LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

35SI00473800 Issued in NJ

Legal business name

INNER WELLTH LLC

Practice address

420 Boulevard
Suite 101
Mountain Lakes, NJ 07046-1742

Phone

(973) 321-4380

Fax

(973) 794-5350

NPI assigned

Jan 26, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Randolph Scott Shipon, PH.D.

Title

Member

Phone

(973) 321-4380

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1327536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327536000000",
    "number": "1992077622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 BOULEVARD",
            "address_2": "SUITE 101",
            "city": "MOUNTAIN LAKES",
            "state": "NJ",
            "postal_code": "070461742",
            "telephone_number": "973-321-4380",
            "fax_number": "973-794-5350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 BOULEVARD",
            "address_2": "SUITE 101",
            "city": "MOUNTAIN LAKES",
            "state": "NJ",
            "postal_code": "070461742",
            "telephone_number": "973-321-4380",
            "fax_number": "973-794-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER WELLTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-26",
        "last_updated": "2012-01-26",
        "status": "A",
        "authorized_official_last_name": "SHIPON",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "973-321-4380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NJ",
            "license": "35SI00473800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; 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.