MEDICARE: NEW LEAF HEALTH AND WELLNESS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1922492685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LEAF HEALTH AND WELLNESS, PC

Provider Business Mailing Address
First Line	:	3 CORBETT WAY STE A
Second Line	:
City	:	EATONTOWN
State	:	NJ
Zip	:	07724-2283
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4828 LAKE WORTH RD STE A
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3456
Country	:	US
Telephone Number	:	609-662-4714
Fax Number	:

Authorized Official
Title or Position	:	MNGR
Name	:	ROBERT WALLACE
Credential	:
Telephone Number	:	609-662-4714

Provider Enumeration Date	:	03/20/2015
Last Update Date	:	03/26/2015

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