Provider Demographics
NPI:1821283490
Name:HAVERON TOTAL HEALTH, PA
Entity Type:Organization
Organization Name:HAVERON TOTAL HEALTH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAVERON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-629-0779
Mailing Address - Street 1:909 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2710
Mailing Address - Country:US
Mailing Address - Phone:908-629-0779
Mailing Address - Fax:908-629-0804
Practice Address - Street 1:909 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2710
Practice Address - Country:US
Practice Address - Phone:908-629-0779
Practice Address - Fax:908-629-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00344800111N00000X
NJ40QA01050700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty