Healthcare Provider Details

I. General information

NPI: 1356215917
Provider Name (Legal Business Name): ROOTS HERBAL HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 13TH ST
EWING NJ
08638-2910
US

IV. Provider business mailing address

28 SPRING ST UNIT 189
PRINCETON NJ
08542-6901
US

V. Phone/Fax

Practice location:
  • Phone: 631-398-8127
  • Fax: 631-398-8127
Mailing address:
  • Phone: 631-398-8127
  • Fax: 631-398-8127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHEVOY SMITH
Title or Position: OWNER / MANAGING MEMBER
Credential: MA, MPH
Phone: 631-398-8127