Provider Demographics
NPI:1588053706
Name:DIABETES EDUCATION AND WELLNESS
Entity type:Organization
Organization Name:DIABETES EDUCATION AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANULLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-500-1477
Mailing Address - Street 1:352 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1616
Mailing Address - Country:US
Mailing Address - Phone:732-500-1477
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:SUITE 226
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3450
Practice Address - Country:US
Practice Address - Phone:732-500-1477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty