Provider Demographics
NPI:1902317738
Name:NU-LYFE WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:NU-LYFE WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KUNAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATHAK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-423-0030
Mailing Address - Street 1:68 RIVERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-4058
Mailing Address - Country:US
Mailing Address - Phone:973-420-0030
Mailing Address - Fax:
Practice Address - Street 1:279 BROWERTOWN RD
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2663
Practice Address - Country:US
Practice Address - Phone:973-420-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111N00000X, 171100000X
NJ40QA01669100225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty