Healthcare Provider Details

I. General information

NPI: 1366715963
Provider Name (Legal Business Name): CHIROMED GROUP BAYONNE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E. 22ND STREET
BAYONNE NJ
07002-3708
US

IV. Provider business mailing address

101 W 24TH ST APT 12A
NEW YORK NY
10011-1909
US

V. Phone/Fax

Practice location:
  • Phone: 201-339-8889
  • Fax: 201-339-2822
Mailing address:
  • Phone: 917-216-3329
  • Fax: 212-867-8226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00180500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08272600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TABISH RIZVI
Title or Position: CEO
Credential:
Phone: 917-216-3329