Healthcare Provider Details

I. General information

NPI: 1518905645
Provider Name (Legal Business Name): BACKSMART WELLNESS CENTER P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 AMBOY AVE
EDISON NJ
08837-3584
US

IV. Provider business mailing address

619 AMBOY AVE
EDISON NJ
08837-3584
US

V. Phone/Fax

Practice location:
  • Phone: 732-661-1121
  • Fax: 732-661-1151
Mailing address:
  • Phone: 732-661-1121
  • Fax: 732-661-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHAEL J LAGANA
Title or Position: PRESIDENT
Credential: D.C.
Phone: 732-661-1121