| Origin Llc | |
|
14 Gallaway Ln Willingboro NJ 08046-3226 | |
| (908) 494-5150 | |
| Not Available |
| Full Name | Origin Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 14 Gallaway Ln, Willingboro, New Jersey |
| Authorized Official Name and Position | Leez-betina Petit (FOUNDER) |
| Authorized Official Contact | 9084945150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Origin Llc 14 Gallaway Ln Willingboro NJ 08046-3226 Ph: () - | Origin Llc 14 Gallaway Ln Willingboro NJ 08046-3226 Ph: (908) 494-5150 |
| NPI Number | 1124691647 |
|---|---|
| Provider Enumeration Date | 07/22/2021 |
| Last Update Date | 07/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124691647 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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