Provider Demographics
NPI:1780035071
Name:MAXIMUM HEALTH & WELLNESS TETERBORO LLC
Entity Type:Organization
Organization Name:MAXIMUM HEALTH & WELLNESS TETERBORO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE REP
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-942-1204
Mailing Address - Street 1:100 HOLLISTER RD
Mailing Address - Street 2:C/O GOLD'S GYM
Mailing Address - City:TETERBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07608-1148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HOLLISTER RD
Practice Address - Street 2:C/O GOLD'S GYM
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608-1148
Practice Address - Country:US
Practice Address - Phone:973-507-9866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty