Organization
WELLCOMECARE PHYSICIAN GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ANASTASI M.D. (PARTNER/ MEDICAL DIRECTOR)
(973) 773-3800
Entity
Organization
Contact information
Practice address
210 PASSAIC ST, GARFIELD, NJ 07026
(973) 773-3800
Mailing address
1373 BROAD ST, SUITE 200, CLIFTON, NJ 07013-4200
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA08742300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217130YEMN
MEDICARE PTAN
—
Enumeration date
09/07/2011
Last updated
09/07/2011
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