Healthcare Provider Details

I. General information

NPI: 1053235846
Provider Name (Legal Business Name): WOLF OF FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 WATERVIEW BLVD APT B1I
PARSIPPANY NJ
07054-7611
US

IV. Provider business mailing address

46 WATERVIEW BLVD APT B1I
PARSIPPANY NJ
07054-7611
US

V. Phone/Fax

Practice location:
  • Phone: 862-253-5618
  • Fax:
Mailing address:
  • Phone: 862-253-5618
  • 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: MR. BRYANT R MASSINGALE
Title or Position: CEO
Credential: SBE MBE
Phone: 862-288-5919