Healthcare Provider Details

I. General information

NPI: 1700948676
Provider Name (Legal Business Name): GIORDANO HOLISTIC WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BROADWAY SUITE 209
METHUEN MA
01844-3003
US

IV. Provider business mailing address

143 SEMINOLE AVE
WALTHAM MA
02451-0858
US

V. Phone/Fax

Practice location:
  • Phone: 978-688-7100
  • Fax:
Mailing address:
  • Phone: 508-878-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1597
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00000698
License Number StateWA

VIII. Authorized Official

Name: DR. PAUL JOSEPH GIORDANO
Title or Position: OWNER
Credential: N.D., L.D.N.
Phone: 508-878-2415