Provider Demographics
NPI:1568890184
Name:ADVANCED CENTER FOR INJURY & WELLNESS CARE
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR INJURY & WELLNESS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAVA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-942-9400
Mailing Address - Street 1:392 TOTOWA RD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2075
Mailing Address - Country:US
Mailing Address - Phone:973-942-9400
Mailing Address - Fax:973-942-9300
Practice Address - Street 1:392 TOTOWA RD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2075
Practice Address - Country:US
Practice Address - Phone:973-942-9400
Practice Address - Fax:973-942-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00098900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty