Provider Demographics
NPI:1689992331
Name:ADVANCING WELLNESS, LLC
Entity Type:Organization
Organization Name:ADVANCING WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERRYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-658-1375
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1445 ROUTE 130
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3100
Practice Address - Country:US
Practice Address - Phone:732-658-1375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3610209Medicaid
NJE32873Medicare UPIN