Healthcare Provider Details

I. General information

NPI: 1528301868
Provider Name (Legal Business Name): NEW JERSEY INSTITUTE OF BALANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 BROADWAY
BAYONNE NJ
07002-3054
US

IV. Provider business mailing address

10 CHURCH TOWERS
HOBOKEN NJ
07030
US

V. Phone/Fax

Practice location:
  • Phone: 201-339-1109
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL S. RUSSO
Title or Position: OWNER
Credential: DPT
Phone: 201-339-1109