Healthcare Provider Details

I. General information

NPI: 1093980666
Provider Name (Legal Business Name): ESSEX VALLEY SPINE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CENTRAL AVE SUITE 307
EAST ORANGE NJ
07018-2835
US

IV. Provider business mailing address

310 CENTRAL AVE SUITE 307
EAST ORANGE NJ
07018-2835
US

V. Phone/Fax

Practice location:
  • Phone: 973-266-7860
  • Fax: 973-266-7861
Mailing address:
  • Phone: 973-266-7860
  • Fax: 973-266-7861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberMC04817
License Number StateNJ

VIII. Authorized Official

Name: DR. VICTOR THOMAS VERLEZZA
Title or Position: PRESIDENT
Credential: D.C.
Phone: 973-266-7860