Provider Demographics
NPI:1881822161
Name:ATLANTIC MEDICINE AND WELLNESS LLC
Entity Type:Organization
Organization Name:ATLANTIC MEDICINE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-528-5533
Mailing Address - Street 1:2399 ROUTE 34
Mailing Address - Street 2:BLDG. A, SUITE 5
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1500
Mailing Address - Country:US
Mailing Address - Phone:732-528-5533
Mailing Address - Fax:732-528-0360
Practice Address - Street 1:2399 ROUTE 34
Practice Address - Street 2:BLDG. A, SUITE 5
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1500
Practice Address - Country:US
Practice Address - Phone:732-528-5533
Practice Address - Fax:732-528-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty