Provider Demographics
NPI:1356440010
Name:ENERGY WELLNESS & FITNESS INC
Entity Type:Organization
Organization Name:ENERGY WELLNESS & FITNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GRATALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-836-9558
Mailing Address - Street 1:244 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3309
Mailing Address - Country:US
Mailing Address - Phone:201-836-9558
Mailing Address - Fax:201-836-7967
Practice Address - Street 1:244 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3309
Practice Address - Country:US
Practice Address - Phone:201-836-9558
Practice Address - Fax:201-836-7967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO3019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJGR451356Medicare ID - Type UnspecifiedPROVIDER AND CEO GRATALE