Healthcare Provider Details

I. General information

NPI: 1891043394
Provider Name (Legal Business Name): RICHARD MACZUGA CHIROPRACTOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 KENNEDY BLVD SUITE C
BAYONNE NJ
07002-3128
US

IV. Provider business mailing address

1160 KENNEDY BLVD SUITE C
BAYONNE NJ
07002-3128
US

V. Phone/Fax

Practice location:
  • Phone: 201-823-0303
  • Fax: 201-436-6180
Mailing address:
  • Phone: 201-823-0303
  • Fax: 201-436-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. RICHARD MACZUGA
Title or Position: OWNER
Credential: DC
Phone: 201-823-0303