Healthcare Provider Details

I. General information

NPI: 1902349152
Provider Name (Legal Business Name): CELLULAR HEALING HEALTH CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 ROUTE 10 SUITE 205
WHIPPANY NJ
07981-1159
US

IV. Provider business mailing address

94 OLD CLINTON RD
FLEMINGTON NJ
08822-5532
US

V. Phone/Fax

Practice location:
  • Phone: 973-559-1212
  • Fax:
Mailing address:
  • Phone: 973-559-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00674100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00351100
License Number StateNJ

VIII. Authorized Official

Name: DR. DEREK FERGUSON
Title or Position: OWNER
Credential: D.C.
Phone: 973-559-1212