Provider Demographics
NPI:1407452378
Name:TRANSFORMATIVE HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:TRANSFORMATIVE HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-227-3233
Mailing Address - Street 1:610 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1400
Mailing Address - Country:US
Mailing Address - Phone:212-227-3233
Mailing Address - Fax:866-548-5687
Practice Address - Street 1:610 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-1400
Practice Address - Country:US
Practice Address - Phone:212-227-3233
Practice Address - Fax:866-548-5687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA10802100OtherMEICAL LICENSE