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General NPI Number Information
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NPI Number | 1356779805
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Entity Type | Organization
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Legal Business Name | NEW LEAF HEALTH AND WELLNESS, P.C.
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Dates
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Enumeration Date | 10/21/2013
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 3 CORBETT WAY STE A
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City | EATONTOWN
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State | NJ
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Zip | 07724-2283
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Country | US
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Telephone | 848-456-2096
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Fax |
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Provider Business Mailing Address
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Address Line | 3 CORBETT WAY SUITE A
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City | EATONTOWN
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State | NJ
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Zip | 07724-2283
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBERT WALLACE
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Credential | D.C.
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Telephone | 848-456-2096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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