Healthcare Provider Details

I. General information

NPI: 1861899668
Provider Name (Legal Business Name): SIGNATURE HEALTH AND WELLNESS NORTH ARLINGTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 SCHUYLER AVE
NORTH ARLINGTON NJ
07031-5424
US

IV. Provider business mailing address

170 SCHUYLER AVE
NORTH ARLINGTON NJ
07031-5424
US

V. Phone/Fax

Practice location:
  • Phone: 551-580-7676
  • Fax: 515-580-7692
Mailing address:
  • Phone: 551-580-7676
  • Fax: 515-580-7692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER R CARROLL
Title or Position: OFFICE REP
Credential:
Phone: 352-942-1908