Provider Demographics
NPI:1982058608
Name:FREEHOLD HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:FREEHOLD HEALTH AND WELLNESS LLC
Other - Org Name:INFINITY HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:732-409-6777
Mailing Address - Street 1:19 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-1218
Mailing Address - Country:US
Mailing Address - Phone:732-409-6777
Mailing Address - Fax:732-409-7435
Practice Address - Street 1:71 W MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2138
Practice Address - Country:US
Practice Address - Phone:732-409-6777
Practice Address - Fax:732-409-7435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00544700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty