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General NPI Number Information
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NPI Number | 1912852104
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Entity Type | Organization
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Legal Business Name | KEEP GLOWING CT3
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 4057 ASBURY AVE STE 21
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City | TINTON FALLS
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State | NJ
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Zip | 07753-7700
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Country | US
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Telephone | 848-217-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 4057 ASBURY AVE STE 21
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City | TINTON FALLS
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State | NJ
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Zip | 07753-7700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL ELLIS
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Credential | DO
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Telephone | 848-217-2662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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