Provider Demographics
NPI:1477185882
Name:PIVOTAL HEALTH AND WELLNESS, INC.
Entity Type:Organization
Organization Name:PIVOTAL HEALTH AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LASTOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-434-4900
Mailing Address - Street 1:2290 10TH AVE N STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6609
Mailing Address - Country:US
Mailing Address - Phone:561-434-4900
Mailing Address - Fax:
Practice Address - Street 1:2290 10TH AVE N STE 102
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-6609
Practice Address - Country:US
Practice Address - Phone:561-434-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty