Organization
INTEGRATIVE WELLNESS & COSMETICS, INC
Active
Other names
Studio 17 Cosmetics & Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIZA WALTER M.D. (MEDICAL DIRECTOR)
(201) 301-4344
Entity
Organization
Contact information
Practice address
601 9TH ST, HOBOKEN, NJ 07030-6428
(201) 301-4344
Mailing address
65 WINDSOR DR, PINE BROOK, NJ 07058-9757
(973) 908-3368
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
25MA09325400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA09325400
MEDICAL LICENSE
NJ
Enumeration date
01/04/2018
Last updated
08/17/2020
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