Provider Demographics
NPI:1225661630
Name:ACTIVE CARE POMPTON LAKES
Entity Type:Organization
Organization Name:ACTIVE CARE POMPTON LAKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE REP
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-789-3227
Mailing Address - Street 1:17 WATCHUNG AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2700
Mailing Address - Country:US
Mailing Address - Phone:973-635-2605
Mailing Address - Fax:973-635-2646
Practice Address - Street 1:203 RAMAPO AVE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1820
Practice Address - Country:US
Practice Address - Phone:973-635-2605
Practice Address - Fax:973-635-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty