Healthcare Provider Details

I. General information

NPI: 1497144364
Provider Name (Legal Business Name): MAXIMUM HEALTH & WELLNESS ROCKAWAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 US HIGHWAY 46
ROCKAWAY NJ
07866-3823
US

IV. Provider business mailing address

295 US HIGHWAY 46
ROCKAWAY NJ
07866-3823
US

V. Phone/Fax

Practice location:
  • Phone: 973-957-0200
  • Fax: 973-957-0201
Mailing address:
  • Phone: 973-957-0200
  • Fax: 973-957-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00722400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
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: 352-942-1204