=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053235846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOLF OF FITNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2026
-----------------------------------------------------
Last Update Date | 08/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 46 WATERVIEW BLVD APT B1I
-----------------------------------------------------
City | PARSIPPANY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07054-7611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-253-5618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 WATERVIEW BLVD APT B1I
-----------------------------------------------------
City | PARSIPPANY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07054-7611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-253-5618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. BRYANT R MASSINGALE
-----------------------------------------------------
Credential | SBE MBE
-----------------------------------------------------
Telephone | 862-288-5919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------