Healthcare Provider Details

I. General information

NPI: 1649123795
Provider Name (Legal Business Name): ECLIPSE HOT YOGA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HADDON AVE STE 2102A
HADDON TOWNSHIP NJ
08108-2600
US

IV. Provider business mailing address

225 HADDON AVE STE 2102A
HADDON TOWNSHIP NJ
08108-2600
US

V. Phone/Fax

Practice location:
  • Phone: 302-287-6710
  • Fax:
Mailing address:
  • Phone: 302-287-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA A RUSSO
Title or Position: OWNER
Credential: DO
Phone: 302-287-6710