Provider Demographics
NPI:1407272453
Name:HEALTH FUSION WELLNESS LLC
Entity Type:Organization
Organization Name:HEALTH FUSION WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:732-665-6334
Mailing Address - Street 1:55 SCHANCK RD
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2964
Mailing Address - Country:US
Mailing Address - Phone:732-665-6334
Mailing Address - Fax:732-683-2477
Practice Address - Street 1:55 SCHANCK RD
Practice Address - Street 2:SUITE A-4
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2964
Practice Address - Country:US
Practice Address - Phone:732-665-6334
Practice Address - Fax:732-683-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00709900111N00000X
NJ40QA01539300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty