Provider Demographics
NPI:1447449566
Name:CHERRY HILL WELLNESS CENTER LLC
Entity type:Organization
Organization Name:CHERRY HILL WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DITOMMASO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-216-1020
Mailing Address - Street 1:1401 ROUTE 70 E
Mailing Address - Street 2:STE 20
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2207
Mailing Address - Country:US
Mailing Address - Phone:856-216-1020
Mailing Address - Fax:816-216-1026
Practice Address - Street 1:1401 ROUTE 70 E
Practice Address - Street 2:STE 20
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2207
Practice Address - Country:US
Practice Address - Phone:856-216-1020
Practice Address - Fax:816-216-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00194000111N00000X
NJ40QA00970400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ117836Medicare PIN