Healthcare Provider Details

I. General information

NPI: 1205694890
Provider Name (Legal Business Name): STRETCH RECOVERY LOUNGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 GODWIN AVE
RIDGEWOOD NJ
07450-3746
US

IV. Provider business mailing address

6 IVY CREST LN
ROCKAWAY NJ
07866-1310
US

V. Phone/Fax

Practice location:
  • Phone: 973-339-3336
  • Fax:
Mailing address:
  • Phone: 201-274-6726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAKE FEURY
Title or Position: FOUNDER
Credential:
Phone: 201-274-6726