Healthcare Provider Details

I. General information

NPI: 1740712314
Provider Name (Legal Business Name): SPINE AND REHABILITATION CENTER OF JERSEY CITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 WESTMINSTER AVE
ELIZABETH NJ
07208-2202
US

IV. Provider business mailing address

3053 KENNEDY BLVD
JERSEY CITY NJ
07306-3605
US

V. Phone/Fax

Practice location:
  • Phone: 908-558-9500
  • Fax:
Mailing address:
  • Phone: 201-839-5380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL LATZA
Title or Position: OWNER
Credential:
Phone: 908-764-7704