MEDICARE: CARE SPINE & SPORTS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	171100000X	Acupuncturist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1902558141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE SPINE & SPORTS, LLC

Provider Business Mailing Address
First Line	:	12 RENE CT
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-8415
Country	:	US
Telephone Number	:	973-420-0030
Fax Number	:

Provider Business Practice Location Address
First Line	:	881 ALLWOOD RD STE 1
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07012-1900
Country	:	US
Telephone Number	:	973-420-0030
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NEHA PATHAK
Credential	:	PT
Telephone Number	:	973-420-0030

Provider Enumeration Date	:	01/19/2022
Last Update Date	:	09/02/2022

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Directions to “CARE SPINE & SPORTS, LLC ” Practice Location

Language	Start Address	Practice Location

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