Healthcare Provider Details

I. General information

NPI: 1619167731
Provider Name (Legal Business Name): CENTRAL JERSEY PHYSICAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 NEW BRUNSWICK AVE SUITE 3
FORDS NJ
08863-2162
US

IV. Provider business mailing address

565 NEW BRUNSWICK AVE SUITE 3
FORDS NJ
08863-2162
US

V. Phone/Fax

Practice location:
  • Phone: 732-661-9575
  • Fax: 732-661-9585
Mailing address:
  • Phone: 732-661-9575
  • Fax: 732-661-9585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number38MC00473200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01051100
License Number StateNJ

VIII. Authorized Official

Name: DR. STEVEN L. FARBER
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 732-661-9575