Healthcare Provider Details

I. General information

NPI: 1851443964
Provider Name (Legal Business Name): NEW JERSEY TOTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ARNOT ST STE 3
LODI NJ
07644-1629
US

IV. Provider business mailing address

2 ARNOT ST STE 3
LODI NJ
07644-1629
US

V. Phone/Fax

Practice location:
  • Phone: 973-472-5433
  • Fax: 973-473-6833
Mailing address:
  • Phone: 973-472-5433
  • Fax: 973-473-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DONNA PERILLO
Title or Position: PART OWNER
Credential: DC
Phone: 973-472-5433