Provider Demographics
NPI:1306036645
Name:ADVANCED WELLNESS OF TOMS RIVER PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:ADVANCED WELLNESS OF TOMS RIVER PROFESSIONAL ASSOCIATION
Other - Org Name:ADVANCED WELLNESS OF TOMS RIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CIFELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-505-9488
Mailing Address - Street 1:300 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6533
Mailing Address - Country:US
Mailing Address - Phone:732-505-9488
Mailing Address - Fax:732-505-9588
Practice Address - Street 1:300 W WATER ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6533
Practice Address - Country:US
Practice Address - Phone:732-505-9488
Practice Address - Fax:732-505-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA011012002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071819Medicare PIN