Provider Demographics
NPI:1205694890
Name:STRETCH RECOVERY LOUNGE
Entity type:Organization
Organization Name:STRETCH RECOVERY LOUNGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-274-6726
Mailing Address - Street 1:6 IVY CREST LN
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1310
Mailing Address - Country:US
Mailing Address - Phone:201-274-6726
Mailing Address - Fax:
Practice Address - Street 1:29 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3746
Practice Address - Country:US
Practice Address - Phone:973-339-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service