Provider Demographics
NPI:1114456944
Name:SYNERGY FITNESS AND WELLNESS LLC
Entity Type:Organization
Organization Name:SYNERGY FITNESS AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-339-9787
Mailing Address - Street 1:1777 HAMBURG TPKE STE 303
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5243
Mailing Address - Country:US
Mailing Address - Phone:973-339-9787
Mailing Address - Fax:
Practice Address - Street 1:1777 HAMBURG TPKE STE 303
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5243
Practice Address - Country:US
Practice Address - Phone:973-339-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA070838002083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty