Provider Demographics
NPI:1942429238
Name:INTEGRATIVE WELLNESS CENTER, P.A.
Entity Type:Organization
Organization Name:INTEGRATIVE WELLNESS CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:POGORELEC
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:973-773-2500
Mailing Address - Street 1:164 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1400
Mailing Address - Country:US
Mailing Address - Phone:973-773-2500
Mailing Address - Fax:973-773-0508
Practice Address - Street 1:164 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1400
Practice Address - Country:US
Practice Address - Phone:973-773-2500
Practice Address - Fax:973-773-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07663200204D00000X, 207QS0010X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Not Answered207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Not Answered2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty