Provider Demographics
NPI:1508241894
Name:FRAGA WELLNESS SOLUTIONS, PC
Entity Type:Organization
Organization Name:FRAGA WELLNESS SOLUTIONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIS STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-655-0103
Mailing Address - Street 1:734 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4274
Mailing Address - Country:US
Mailing Address - Phone:201-858-0444
Mailing Address - Fax:201-858-4049
Practice Address - Street 1:734 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4274
Practice Address - Country:US
Practice Address - Phone:201-858-0444
Practice Address - Fax:201-858-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00728400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty