| Organization Name: | CLEAR WATERS HEALTH AND WELLNESS PC |
| NPI Number: | 1104200484 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JULIE LEIB (OWNER) |
| Mailing Address: | 615 Hope Road , Building 5b, 2f Attn: Mr. Kurt Ferber Tinton Falls |
| State: | NJ US |
| Postal Code: | 07724 |
| Phone Number: | 8007104300 |
| Fax Number: | |
| NPI Enumeration Date: | 07/16/2015 |
| NPI Last Update Date: | 07/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |