Healthcare Provider Details

I. General information

NPI: 1447449566
Provider Name (Legal Business Name): CHERRY HILL WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ROUTE 70 E STE 20
CHERRY HILL NJ
08034-2207
US

IV. Provider business mailing address

1401 ROUTE 70 E STE 20
CHERRY HILL NJ
08034-2207
US

V. Phone/Fax

Practice location:
  • Phone: 856-216-1020
  • Fax: 816-216-1026
Mailing address:
  • Phone: 856-216-1020
  • Fax: 816-216-1026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00194000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00970400
License Number StateNJ

VIII. Authorized Official

Name: DR. GUY A DITOMMASO
Title or Position: OWNER/OPERATOR
Credential: D.C.
Phone: 856-216-1020