Provider Demographics
NPI:1205389343
Name:ENERGY ZONE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ENERGY ZONE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYBINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-366-4837
Mailing Address - Street 1:700 PALISADIUM DR
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3239
Mailing Address - Country:US
Mailing Address - Phone:201-366-4837
Mailing Address - Fax:
Practice Address - Street 1:700 PALISADIUM DR
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3239
Practice Address - Country:US
Practice Address - Phone:201-366-4837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00995800261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy