Basic Information
| Provider Information | |||||||||
| NPI: | 1285005884 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH JERSEY HEALTH AND WELLNESS LLC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 227 DONNY BROOK DR | ||||||||
| Address2: | |||||||||
| City: | ALLENDALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074011422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018198545 | ||||||||
| FaxNumber: | 8054735931 | ||||||||
| Practice Location | |||||||||
| Address1: | 227 DONNY BROOK DR | ||||||||
| Address2: | |||||||||
| City: | ALLENDALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074011422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018198545 | ||||||||
| FaxNumber: | 8054735931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2015 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BERBERIAN | ||||||||
| AuthorizedOfficialFirstName: | DEREK | ||||||||
| AuthorizedOfficialMiddleName: | BRUCE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2018198545 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 261QM1300X | 25MA09655600 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.