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NPI Code Detail

MEDICARE: JERSEY CITY NECK & BACK CENTER, PC

MEDICARE: JERSEY CITY NECK & BACK CENTER, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist40QA01212100NJ
2111N00000XChiropractorMCO-6174NJ

General Provider Information

NPI Number : 1437359114
Entity Type Code : Organization
Provider Name (Legal Business Name) : JERSEY CITY NECK & BACK CENTER, PC
Provider Business Mailing Address
First Line : 590 NEWARK AVE
Second Line : SUITE 2A
City : JERSEY CITY
State : NJ
Zip : 07306-2302
Country : US
Telephone Number : 201-420-1165
Fax Number : 201-420-6893
Provider Business Practice Location Address
First Line : 590 NEWARK AVE
Second Line : SUITE 2A
City : JERSEY CITY
State : NJ
Zip : 07306-2302
Country : US
Telephone Number : 201-420-1165
Fax Number : 201-420-6893
Authorized Official
Title or Position : DIRECTOR
Name : DR. CHARLES EDWARD MASCENIK JR.
Credential : D.C.
Telephone Number : 201-420-1165
Provider Enumeration Date : 07/20/2007
Last Update Date : 11/08/2007

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