Healthcare Provider Details

I. General information

NPI: 1104659614
Provider Name (Legal Business Name): TOTAL LIFE NJ P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 GEORGE ST STE 320
NEW BRUNSWICK NJ
08901-2091
US

IV. Provider business mailing address

110 FRONT ST STE 300
JUPITER FL
33477-5095
US

V. Phone/Fax

Practice location:
  • Phone: 800-567-5433
  • Fax: 888-432-8212
Mailing address:
  • Phone: 800-567-5433
  • Fax: 888-432-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: NEELKAMAL BRAR
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 800-567-5433