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General NPI Number Information
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NPI Number | 1760641757
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Entity Type | Organization
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Legal Business Name | IVY LEAGUE HEALTH & FITNESS
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 10/30/2011
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Provider Practice Location Address
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Address Line | 66 WITHERSPOON ST
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City | PRINCETON
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State | NJ
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Zip | 08542-3239
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Country | US
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Telephone | 609-925-1159
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Fax |
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Provider Business Mailing Address
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Address Line | 66 WITHERSPOON ST PMB 403
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City | PRINCETON
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State | NJ
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Zip | 08542-3226
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Country | US
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Telephone | 609-925-1159
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Fax | 609-925-1159
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Authorized Official
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Title or Position | DIRECTOR OF TRAINING
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Name | MR. DAVID NOGAKI
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Credential | C.S.C.S
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Telephone | 609-925-1159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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