Organization
INNER WELLTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDOLPH SCOTT SHIPON PH.D. (MEMBER)
(973) 321-4380
Entity
Organization
Contact information
Practice address
420 BOULEVARD, SUITE 101, MOUNTAIN LAKES, NJ 07046-1742
(973) 321-4380
(973) 794-5350
Mailing address
420 BOULEVARD, SUITE 101, MOUNTAIN LAKES, NJ 07046-1742
(973) 321-4380
(973) 794-5350
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
35SI00473800
NJ
Other
Enumeration date
01/26/2012
Last updated
01/26/2012
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