Healthcare Provider Details

I. General information

NPI: 1922500990
Provider Name (Legal Business Name): MAXIMUM HEALTH & WELLNESS MANVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 US 22
GREEN BROOK TWSP NJ
08812
US

IV. Provider business mailing address

PO BOX 459
RARITAN NJ
08869-0459
US

V. Phone/Fax

Practice location:
  • Phone: 352-678-3092
  • Fax: 866-728-1673
Mailing address:
  • Phone: 352-678-3092
  • Fax: 866-728-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00749700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CARROLL
Title or Position: OFFICE REP
Credential:
Phone: 352-678-3092