Avant Garde Total Wellness Centers LLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

Legal business name

AVANT GARDE TOTAL WELLNESS CENTERS LLC

Practice address

66 Newark Pompton Tpke
Riverdale, NJ 07457-1420

Phone

(973) 858-9000

NPI assigned

Nov 12, 2021

Last updated

Nov 12, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert Wilson, LMT CLTNPI 1255098919

Title

Owner

Phone

(201) 615-7317

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert Wilson, MT CLT

  • Massage Therapist
  • Riverdale, NJ
  • NPI 1255098919

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636675200000",
    "number": "1184380230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 MACOPIN RD",
            "city": "WEST MILFORD",
            "state": "NJ",
            "postal_code": "074801508",
            "telephone_number": "201-615-7317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 NEWARK POMPTON TPKE",
            "city": "RIVERDALE",
            "state": "NJ",
            "postal_code": "074571420",
            "telephone_number": "973-858-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANT GARDE TOTAL WELLNESS CENTERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-12",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-615-7317",
        "authorized_official_credential": "LMT CLT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Riverdale, NJ
• Providers in Riverdale, NJ by specialty
• Massage Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.