Provider Demographics
NPI:1851029276
Name:HOLISTIC BODY WELLNESS, PC
Entity Type:Organization
Organization Name:HOLISTIC BODY WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRIMARY PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ULYSES
Authorized Official - Middle Name:FAVIAN
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-873-2955
Mailing Address - Street 1:57 DEMAREST RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2109
Mailing Address - Country:US
Mailing Address - Phone:201-725-9201
Mailing Address - Fax:
Practice Address - Street 1:MOBILE CLINIC
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2109
Practice Address - Country:US
Practice Address - Phone:201-725-9201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center