Healthcare Provider Details

I. General information

NPI: 1649665803
Provider Name (Legal Business Name): HEAT HOLISTIC LIFESTYLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 SIMPSON AVE
NATIONAL PARK NJ
08063-1441
US

IV. Provider business mailing address

1109 SIMPSON AVE
NATIONAL PARK NJ
08063-1441
US

V. Phone/Fax

Practice location:
  • Phone: 856-870-9501
  • Fax:
Mailing address:
  • Phone: 856-870-9501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ALICIA JOHNSON
Title or Position: CLINICIAN/SUPPORT COORDINATOR
Credential:
Phone: 856-870-9501