Healthcare Provider Details

I. General information

NPI: 1942308671
Provider Name (Legal Business Name): GEORGE C SCORDILIS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GEORGE C SCORDILIS DC

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/19/2010
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 Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00175000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: