Provider Demographics
NPI:1891064846
Name:ADVANCED HEALING & PAIN RELIEF CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED HEALING & PAIN RELIEF CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILLEMSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-349-0342
Mailing Address - Street 1:2414 MORRIS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5708
Mailing Address - Country:US
Mailing Address - Phone:908-349-0342
Mailing Address - Fax:
Practice Address - Street 1:2414 MORRIS AVE STE 101
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5708
Practice Address - Country:US
Practice Address - Phone:908-349-0342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 225100000X
NJ38MC00689200305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of Service
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01007300OtherPHYSICAL THERAPY LICENSE
NJ38MC00689200OtherCHIROPRACTIC LICENSE