Provider Demographics
NPI:1568671840
Name:KWAKS WELLNESS SYSTEM INC
Entity type:Organization
Organization Name:KWAKS WELLNESS SYSTEM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-356-2828
Mailing Address - Street 1:172 WASHINGTON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-7133
Mailing Address - Country:US
Mailing Address - Phone:732-356-2828
Mailing Address - Fax:732-356-2466
Practice Address - Street 1:172 WASHINGTON VALLEY RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-7133
Practice Address - Country:US
Practice Address - Phone:732-356-2828
Practice Address - Fax:732-356-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization