Provider Demographics
NPI:1407010291
Name:FLEXWELLNESS OF TETERBORO
Entity Type:Organization
Organization Name:FLEXWELLNESS OF TETERBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOSIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-844-1155
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07511-0624
Mailing Address - Country:US
Mailing Address - Phone:973-844-1155
Mailing Address - Fax:973-844-1133
Practice Address - Street 1:100 HOLLISTER RD
Practice Address - Street 2:
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608-1148
Practice Address - Country:US
Practice Address - Phone:201-288-5400
Practice Address - Fax:201-288-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00574800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty