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General NPI Number Information
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NPI Number | 1679909030
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Entity Type | Organization
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Legal Business Name | 21ST CENTURY TOTAL HEALTH CLINIC PC
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 439 MAIN ST SUITE 101
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City | ORANGE
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State | NJ
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Zip | 07050-1523
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Country | US
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Telephone | 973-675-8700
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Fax | 973-675-8701
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Provider Business Mailing Address
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Address Line | 439 MAIN ST SUITE 101
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City | ORANGE
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State | NJ
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Zip | 07050-1523
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Country | US
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Telephone | 973-675-8700
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Fax | 973-675-8701
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Authorized Official
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Title or Position | PRESIDENT
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Name | KESNOLD BAPTISTE
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Credential | DC
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Telephone | 908-625-7463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 38MCOO641500
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License Number State | NJ
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