Provider Demographics
NPI:1649589516
Name:ACTIVE CENTER FOR HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:ACTIVE CENTER FOR HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-343-2277
Mailing Address - Street 1:25 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1960
Mailing Address - Country:US
Mailing Address - Phone:201-343-2277
Mailing Address - Fax:201-343-7410
Practice Address - Street 1:25 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1960
Practice Address - Country:US
Practice Address - Phone:201-343-2277
Practice Address - Fax:201-343-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty