Healthcare Provider Details

I. General information

NPI: 1982158267
Provider Name (Legal Business Name): SPINE AND REHABILITATION CENTER OF BELLEVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 WASHINGTON AVE
BELLEVILLE NJ
07109-3252
US

IV. Provider business mailing address

383 WASHINGTON AVE
BELLEVILLE NJ
07109-3252
US

V. Phone/Fax

Practice location:
  • Phone: 973-302-7936
  • Fax:
Mailing address:
  • Phone: 973-302-7936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL LATZA
Title or Position: MANAGER
Credential: DC
Phone: 908-322-8300