Healthcare Provider Details

I. General information

NPI: 1528477577
Provider Name (Legal Business Name): MAXIMUM HEALTH & WELLNESS WEST ORANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PROSPECT AVE
WEST ORANGE NJ
07052-4228
US

IV. Provider business mailing address

PO BOX 138
EAST HANOVER NJ
07936-0138
US

V. Phone/Fax

Practice location:
  • Phone: 973-243-0008
  • Fax: 973-243-0038
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 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