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Organization

WELLNESS 360 LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANANT NISCHAL PA, PHD (OWNER, PA)
(732) 719-6864
Entity
Organization

Contact information

Practice address
145 ROUTE 34, MATAWAN, NJ 07747-2187
(732) 719-6864
Mailing address
200 PERRINE RD STE 230, OLD BRIDGE, NJ 08857-2871
(732) 707-3545
(732) 707-3546

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Enumeration date
09/25/2023
Last updated
09/25/2023
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