Healthcare Provider Details

I. General information

NPI: 1184420036
Provider Name (Legal Business Name): NJ PERFORMANCE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 RUES LN
EAST BRUNSWICK NJ
08816-3755
US

IV. Provider business mailing address

32 MULBERRY DR
MANALAPAN NJ
07726-4172
US

V. Phone/Fax

Practice location:
  • Phone: 908-907-0746
  • Fax:
Mailing address:
  • Phone: 908-907-0746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JARED BORNSTEIN
Title or Position: OWNER
Credential:
Phone: 908-907-0746