Provider Demographics
NPI:1205926698
Name:WEST MILFORD WELLNESS CENTER P.C.
Entity type:Organization
Organization Name:WEST MILFORD WELLNESS CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIMMENTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-728-0404
Mailing Address - Street 1:1616 C UNION VALLEY ROAD
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480
Mailing Address - Country:US
Mailing Address - Phone:973-728-0404
Mailing Address - Fax:973-728-0484
Practice Address - Street 1:1616 UNION VALLEY ROAD
Practice Address - Street 2:SUITE 102 A
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480
Practice Address - Country:US
Practice Address - Phone:973-728-0404
Practice Address - Fax:973-728-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMCO3589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT88166Medicare UPIN
NJ080243Medicare ID - Type UnspecifiedPROVIDER NUMBER