Healthcare Provider Details

I. General information

NPI: 1407272453
Provider Name (Legal Business Name): HEALTH FUSION WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SCHANCK RD SUITE A-4
FREEHOLD NJ
07728-2964
US

IV. Provider business mailing address

55 SCHANCK RD SUITE A-4
FREEHOLD NJ
07728-2964
US

V. Phone/Fax

Practice location:
  • Phone: 732-665-6334
  • Fax: 732-683-2477
Mailing address:
  • Phone: 732-665-6334
  • Fax: 732-683-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01539300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00709900
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHAEL WALTER DIMARCO II
Title or Position: OWNER
Credential: D.C.
Phone: 732-665-6334