Provider Demographics
NPI:1366735821
Name:INTEGRATIVE RECOVERY & WELLNESS CLINIC
Entity type:Organization
Organization Name:INTEGRATIVE RECOVERY & WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETRU
Authorized Official - Middle Name:E
Authorized Official - Last Name:IFTODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-678-1999
Mailing Address - Street 1:1 SEARS DR
Mailing Address - Street 2:4TH. FLOOR
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3515
Mailing Address - Country:US
Mailing Address - Phone:201-678-1999
Mailing Address - Fax:201-815-2535
Practice Address - Street 1:1 SEARS DR
Practice Address - Street 2:4TH. FLOOR
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3515
Practice Address - Country:US
Practice Address - Phone:201-678-1999
Practice Address - Fax:201-815-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000503-11261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder