Provider Demographics
NPI:1013573047
Name:ADAPTIVE HEALTHCARE PA
Entity Type:Organization
Organization Name:ADAPTIVE HEALTHCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELWARTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-223-2266
Mailing Address - Street 1:1075 STEPHENSON AVE STE D-2
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1242
Mailing Address - Country:US
Mailing Address - Phone:833-223-2266
Mailing Address - Fax:732-783-0323
Practice Address - Street 1:1075 STEPHENSON AVE STE D-2
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1242
Practice Address - Country:US
Practice Address - Phone:833-223-2266
Practice Address - Fax:732-783-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty