=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164371985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORTIVA WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2026
-----------------------------------------------------
Last Update Date | 01/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 160 E HANOVER AVE STE 104
-----------------------------------------------------
City | CEDAR KNOLLS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07927-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-887-6100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1014
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07962-1014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANIELA ACCURSO
-----------------------------------------------------
Credential | MD, MPH, DABOM
-----------------------------------------------------
Telephone | 732-887-6100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------