| NPI | 1104211952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CEDRICK MATTHEW TERRELL Owner 201-878-1622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC0700X Psychologist Clinical | |
| 103TE1100X Psychologist Exercise & Sports | |
| 133N00000X Nutritionist | |
| 133V00000X Dietitian, Registered | |
| 163W00000X Registered Nurse | |
| 174H00000X Health Educator | |
| 224Y00000X Clinical Exercise Physiologist | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2015-03-30 |