Healthcare Provider Details

I. General information

NPI: 1679258370
Provider Name (Legal Business Name): GREATER NEW JERSEY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GLENWOOD AVE
EAST ORANGE NJ
07017-1055
US

IV. Provider business mailing address

7 GLENWOOD AVE
EAST ORANGE NJ
07017-1055
US

V. Phone/Fax

Practice location:
  • Phone: 516-909-3464
  • Fax:
Mailing address:
  • Phone: 516-909-3464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. GLENN ROSENBERG
Title or Position: PRESIDENT
Credential: DC
Phone: 516-909-3464