Healthcare Provider Details

I. General information

NPI: 1508594979
Provider Name (Legal Business Name): INJURY CARE CENTER OF EAST ORANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CENTRAL AVE STE 203
EAST ORANGE NJ
07018-2838
US

IV. Provider business mailing address

310 CENTRAL AVE STE 203
EAST ORANGE NJ
07018-2838
US

V. Phone/Fax

Practice location:
  • Phone: 862-930-3820
  • Fax: 862-930-3821
Mailing address:
  • Phone: 862-930-3820
  • Fax: 862-930-3821

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: FERNANDO BARRESE
Title or Position: OWNER
Credential: DC
Phone: 862-930-3820