Healthcare Provider Details

I. General information

NPI: 1356253033
Provider Name (Legal Business Name): SUPREME BODY TRAINING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 GREENTREE RD BLDG 1
SEWELL NJ
08080-9328
US

IV. Provider business mailing address

460 GREENTREE RD BLDG 1
SEWELL NJ
08080-9328
US

V. Phone/Fax

Practice location:
  • Phone: 856-434-7265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MARK SAMUELS
Title or Position: OWNER
Credential:
Phone: 856-434-7265