Healthcare Provider Details

I. General information

NPI: 1962915504
Provider Name (Legal Business Name): BRIELLE INTEGRATED HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 HIGGINS AVE
BRIELLE NJ
08730-1427
US

IV. Provider business mailing address

2373 HIGHWAY 36
ATLANTIC HIGHLANDS NJ
07716-2560
US

V. Phone/Fax

Practice location:
  • Phone: 732-872-6595
  • Fax:
Mailing address:
  • Phone: 732-872-6595
  • Fax: 732-872-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JOHN J MAZZELLA
Title or Position: OWNER
Credential:
Phone: 732-872-6595