=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538029020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW WAVE HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2025
-----------------------------------------------------
Last Update Date | 11/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2600 GLASGOW AVE STE 200 SUITE 200
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19702-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-400-5004
-----------------------------------------------------
Fax | 302-444-8312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2600 GLASGOW AVE STE 200
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19702-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-500-4412
-----------------------------------------------------
Fax | 302-444-8312
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. ANDREW LEITZKE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 302-367-8765
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 202D00000X
-----------------------------------------------------
Taxonomy Name | Integrative Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------