Provider Demographics
NPI:1326053273
Name:ADVANCED WELLNESS
Entity Type:Organization
Organization Name:ADVANCED WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:CILEA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-431-2155
Mailing Address - Street 1:17 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1439
Mailing Address - Country:US
Mailing Address - Phone:732-431-2155
Mailing Address - Fax:732-431-2889
Practice Address - Street 1:17 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1439
Practice Address - Country:US
Practice Address - Phone:732-431-2155
Practice Address - Fax:732-431-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00482900111N00000X
NJ25MZ00039600171100000X
NJ25MA08049100174400000X
NJ40QA00986100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ042386Medicare PIN
NJ5924040001Medicare NSC