Healthcare Provider Details

I. General information

NPI: 1215206669
Provider Name (Legal Business Name): FAIRFIELD WELLNESS AND PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GREENBROOK RD
FAIRFIELD NJ
07004-3890
US

IV. Provider business mailing address

25 GREENBROOK RD
FAIRFIELD NJ
07004-3890
US

V. Phone/Fax

Practice location:
  • Phone: 973-403-9911
  • Fax: 973-403-9912
Mailing address:
  • Phone: 973-403-9911
  • Fax: 973-403-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00643100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT40QA01022800
License Number StateNJ

VIII. Authorized Official

Name: DR. SEAN MCLAUGHLIN
Title or Position: OWNER
Credential: D.C.
Phone: 973-403-9911