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General NPI Number Information
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NPI Number | 1821283490
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Entity Type | Organization
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Legal Business Name | HAVERON TOTAL HEALTH, PA
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 909 ELIZABETH AVE
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City | ELIZABETH
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State | NJ
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Zip | 07201-2710
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Country | US
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Telephone | 908-629-0779
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Fax | 908-629-0804
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Provider Business Mailing Address
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Address Line | 909 ELIZABETH AVE
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City | ELIZABETH
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State | NJ
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Zip | 07201-2710
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Country | US
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Telephone | 908-629-0779
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Fax | 908-629-0804
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS M. HAVERON
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Credential | DC
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Telephone | 908-629-0779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01050700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00344800
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License Number State | NJ
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