Provider Demographics
NPI:1386947448
Name:ORGANIQUE LLC
Entity type:Organization
Organization Name:ORGANIQUE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SORVILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MSOM, LOBT
Authorized Official - Phone:973-491-0022
Mailing Address - Street 1:140 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3326
Mailing Address - Country:US
Mailing Address - Phone:973-491-0022
Mailing Address - Fax:973-368-2287
Practice Address - Street 1:140 WILSON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3326
Practice Address - Country:US
Practice Address - Phone:973-491-0022
Practice Address - Fax:973-368-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00052800171100000X
FLAP 1723171100000X
NJ26BT00029800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty