Healthcare Provider Details

I. General information

NPI: 1922354943
Provider Name (Legal Business Name): NJ SPINE AND NEUROPATHY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ENGLE ST SUITE 21
ENGLEWOOD NJ
07631-2440
US

IV. Provider business mailing address

200 ENGLE ST SUITE 21
ENGLEWOOD NJ
07631-2440
US

V. Phone/Fax

Practice location:
  • Phone: 201-739-4992
  • Fax:
Mailing address:
  • Phone: 201-739-4992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT MCGRATH
Title or Position: OWNER/ CLINIC DIRECTOR
Credential: D.C.
Phone: 201-739-4992