Provider Demographics
NPI:1346577277
Name:ADVANCED PHYSICAL HEALTH CENTER PC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:SANDY
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-824-0748
Mailing Address - Street 1:35 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06018-2466
Mailing Address - Country:US
Mailing Address - Phone:860-824-0748
Mailing Address - Fax:860-824-0749
Practice Address - Street 1:35 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06018-2466
Practice Address - Country:US
Practice Address - Phone:860-824-0748
Practice Address - Fax:860-824-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001818111N00000X
NJ38MC00629800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV07685Medicare UPIN
NJ096724Medicare PIN