Healthcare Provider Details

I. General information

NPI: 1326053273
Provider Name (Legal Business Name): ADVANCED WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 N MAIN ST
MARLBORO NJ
07746-1439
US

IV. Provider business mailing address

17 N MAIN ST
MARLBORO NJ
07746-1439
US

V. Phone/Fax

Practice location:
  • Phone: 732-431-2155
  • Fax: 732-431-2889
Mailing address:
  • Phone: 732-431-2155
  • Fax: 732-431-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00482900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00039600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA08049100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00986100
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSEPH J CILEA
Title or Position: PRESIDENT
Credential: D.C.
Phone: 732-431-2155