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General NPI Number Information
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NPI Number | 1821505462
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE WELLNESS & COSMETICS, INC
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 601 9TH ST
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City | HOBOKEN
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State | NJ
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Zip | 07030-6428
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Country | US
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Telephone | 201-301-4344
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Fax |
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Provider Business Mailing Address
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Address Line | 65 WINDSOR DR
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City | PINE BROOK
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State | NJ
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Zip | 07058-9757
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Country | US
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Telephone | 973-908-3368
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BRIZA WALTER
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Credential | M.D.
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Telephone | 201-301-4344
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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 | 25MA09325400
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License Number State | NJ
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