Provider Demographics
NPI:1083591895
Name:MPATH WELLNESS CENTER LLC
Entity type:Organization
Organization Name:MPATH WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTIVERNE
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:973-534-1600
Mailing Address - Street 1:103 WALL ST
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1774
Mailing Address - Country:US
Mailing Address - Phone:908-344-7230
Mailing Address - Fax:
Practice Address - Street 1:250 STELTON RD STE 1
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3285
Practice Address - Country:US
Practice Address - Phone:908-344-7230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)