Provider Demographics
NPI:1346401890
Name:MAXIMIZED LIVING & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:MAXIMIZED LIVING & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KANER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-794-4500
Mailing Address - Street 1:23-08 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1583
Mailing Address - Country:US
Mailing Address - Phone:201-794-4500
Mailing Address - Fax:201-794-4502
Practice Address - Street 1:23-08 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1583
Practice Address - Country:US
Practice Address - Phone:201-794-4500
Practice Address - Fax:201-794-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty