Organization
MENTALWELLNESSMD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KALLIOPI S NISSIRIOS MD (OWNER/DIRECTOR)
(201) 987-0909
Entity
Organization
Contact information
Practice address
93 FRANKLIN TPKE STE 202, WALDWICK, NJ 07463-1859
(201) 987-0909
Mailing address
93 FRANKLIN TPKE STE 202, WALDWICK, NJ 07463-1859
(201) 987-0909
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Enumeration date
09/07/2022
Last updated
07/10/2024
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