MEDICARE: HEALTHY WALK LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1467834796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY WALK LLC

Provider Business Mailing Address
First Line	:	515 LINCOLN HWY
Second Line	:
City	:	ISELIN
State	:	NJ
Zip	:	08830-1766
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 LINCOLN HWY
Second Line	:
City	:	ISELIN
State	:	NJ
Zip	:	08830-1766
Country	:	US
Telephone Number	:	848-467-8441
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SANKET RUPARELIYA
Credential	:
Telephone Number	:	848-467-8441

Provider Enumeration Date	:	06/23/2015
Last Update Date	:	06/23/2015

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Directions to “HEALTHY WALK LLC ” Practice Location

Language	Start Address	Practice Location

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