Healthcare Provider Details

I. General information

NPI: 1376117853
Provider Name (Legal Business Name): LIFESTYLE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 MADISON AVE STE 3A
MORRISTOWN NJ
07960-7401
US

IV. Provider business mailing address

224 NORWICH CT
MADISON NJ
07940-1134
US

V. Phone/Fax

Practice location:
  • Phone: 973-590-2448
  • Fax: 973-590-2449
Mailing address:
  • Phone: 973-900-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CYNTHIA D'AMELIO
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 973-900-0238