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General NPI Number Information
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NPI Number | 1467890970
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL HEALTH PC
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Dates
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Enumeration Date | 06/06/2013
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Last Update Date | 06/06/2013
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Provider Practice Location Address
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Address Line | 32 ROOSEVELT PLACE
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City | SOMERVILLE
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State | NJ
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Zip | 08876
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Country | US
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Telephone | 908-722-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 32 ROOSEVELT PLACE
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City | SOMERVILLE
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State | NJ
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Zip | 08876
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Country | US
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Telephone | 908-722-0500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER WAWRZYNIAK
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Credential | D.C
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Telephone | 908-722-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 38MC00672100
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License Number State | NJ
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