Provider Demographics
NPI:1316078157
Name:INTEGRATED HEALTH AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:INTEGRATED HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-922-4462
Mailing Address - Street 1:3520 STATE ROUTE 33 STE B
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3015
Mailing Address - Country:US
Mailing Address - Phone:732-922-4462
Mailing Address - Fax:732-922-4897
Practice Address - Street 1:2640 HIGHWAY 70
Practice Address - Street 2:BUILDING 12 SUITE 201
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730
Practice Address - Country:US
Practice Address - Phone:732-922-4462
Practice Address - Fax:732-922-4897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075343Medicare ID - Type UnspecifiedFACILITY NUMBER