Healthcare Provider Details

I. General information

NPI: 1316078157
Provider Name (Legal Business Name): INTEGRATED HEALTH AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 HIGHWAY 70 BUILDING 12 SUITE 201
BRIELLE NJ
08730
US

IV. Provider business mailing address

3520 STATE ROUTE 33 STE B
NEPTUNE NJ
07753-3015
US

V. Phone/Fax

Practice location:
  • Phone: 732-922-4462
  • Fax: 732-922-4897
Mailing address:
  • Phone: 732-922-4462
  • Fax: 732-922-4897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LORETTA L CHRISTENSEN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 732-922-4462