Healthcare Provider Details

I. General information

NPI: 1295548824
Provider Name (Legal Business Name): MARIE ELAINA PANGILINAN NBC-WHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 LAKE CHAMPLAIN DR
LITTLE EGG HARBOR TWP NJ
08087-1743
US

IV. Provider business mailing address

232 LAKE CHAMPLAIN DR
LITTLE EGG HARBOR TWP NJ
08087-1743
US

V. Phone/Fax

Practice location:
  • Phone: 732-773-7548
  • Fax:
Mailing address:
  • Phone: 732-773-7548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01237100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3237043
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: