Provider Demographics
NPI:1063374601
Name:LEBANON WELLNESS
Entity type:Organization
Organization Name:LEBANON WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAVKAT
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUZIEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-297-7900
Mailing Address - Street 1:974 ISABEL DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7482
Mailing Address - Country:US
Mailing Address - Phone:717-297-7900
Mailing Address - Fax:717-276-7323
Practice Address - Street 1:245 BLOOMFIELD DR STE 210
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7788
Practice Address - Country:US
Practice Address - Phone:717-297-7900
Practice Address - Fax:717-276-7323
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEBANON WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty