Provider Demographics
NPI:1780422766
Name:PUREBODY WELLNESS
Entity type:Organization
Organization Name:PUREBODY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MOGRABI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-319-4974
Mailing Address - Street 1:25-15 FAIR LAWN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3434
Mailing Address - Country:US
Mailing Address - Phone:973-741-0649
Mailing Address - Fax:
Practice Address - Street 1:25-15 FAIR LAWN AVE STE 2
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3434
Practice Address - Country:US
Practice Address - Phone:973-741-0649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty