Healthcare Provider Details

I. General information

NPI: 1639088073
Provider Name (Legal Business Name): RENEW360 PROFESSIONAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 ROUTE 37 WEST
TOMS RIVER NJ
08755-4919
US

IV. Provider business mailing address

1181 ROUTE 37 WEST
TOMS RIVER NJ
08755-4919
US

V. Phone/Fax

Practice location:
  • Phone: 732-234-0058
  • Fax:
Mailing address:
  • Phone: 732-234-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ADREYANNA HARVEY
Title or Position: CLINICAL DIRECTOR
Credential: LPC
Phone: 732-234-0058