Healthcare Provider Details

I. General information

NPI: 1124237052
Provider Name (Legal Business Name): CLIFTON SPINE SPORTS & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 BROAD ST SUITE#106
CLIFTON NJ
07013-3346
US

IV. Provider business mailing address

1135 BROAD ST SUITE#106
CLIFTON NJ
07013-3346
US

V. Phone/Fax

Practice location:
  • Phone: 973-473-4481
  • Fax: 973-473-8852
Mailing address:
  • Phone: 973-473-4481
  • Fax: 973-473-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GEORGE CONSTANTINE SCORDILIS
Title or Position: PARTNER
Credential: D.C.
Phone: 973-473-4481