Healthcare Provider Details

I. General information

NPI: 1093038689
Provider Name (Legal Business Name): BLOOMFIELD SPINE & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 BROAD ST SUITE 207
BLOOMFIELD NJ
07003-3000
US

IV. Provider business mailing address

1255 BROAD ST SUITE 207
BLOOMFIELD NJ
07003-3000
US

V. Phone/Fax

Practice location:
  • Phone: 973-233-7104
  • Fax:
Mailing address:
  • Phone: 973-233-7104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00679600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. VINCENT M TAFFURI JR.
Title or Position: OWNER
Credential: DC
Phone: 973-233-7104