Provider Demographics
NPI:1700948676
Name:GIORDANO HOLISTIC WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:GIORDANO HOLISTIC WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GIORDANO
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LDN
Authorized Official - Phone:508-878-2415
Mailing Address - Street 1:143 SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-0858
Mailing Address - Country:US
Mailing Address - Phone:508-878-2415
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY
Practice Address - Street 2:SUITE 209
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-3003
Practice Address - Country:US
Practice Address - Phone:978-688-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1597133N00000X
WANT00000698175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty