Provider Demographics
NPI:1306089792
Name:WELLNESS CONSULTATION SERVICES LLC
Entity type:Organization
Organization Name:WELLNESS CONSULTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:DUBOV
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED DIETITIAN
Authorized Official - Phone:732-816-1651
Mailing Address - Street 1:6 ASPEN CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3345
Mailing Address - Country:US
Mailing Address - Phone:732-816-1651
Mailing Address - Fax:732-238-9509
Practice Address - Street 1:8 OLD BRIDGE TPKE
Practice Address - Street 2:
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-2400
Practice Address - Country:US
Practice Address - Phone:732-390-4888
Practice Address - Fax:732-390-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00634638261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ053650OtherMEDICARE PROVIDER NUMBER