Provider Demographics
NPI:1295093920
Name:VOLT WELLNESS TOO
Entity type:Organization
Organization Name:VOLT WELLNESS TOO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAQRLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-739-9300
Mailing Address - Street 1:566 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1333
Mailing Address - Country:US
Mailing Address - Phone:201-857-3801
Mailing Address - Fax:201-857-3802
Practice Address - Street 1:566 S BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1333
Practice Address - Country:US
Practice Address - Phone:201-857-3801
Practice Address - Fax:201-857-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities