Healthcare Provider Details

I. General information

NPI: 1215123641
Provider Name (Legal Business Name): CENTRAL JERSEY SPINE & WELLNESS L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 ROUTE 9 N BUILDING 3 SUITE B
FREEHOLD NJ
07728-8303
US

IV. Provider business mailing address

4251 ROUTE 9 N BUILDING 3 SUITE B
FREEHOLD NJ
07728-8303
US

V. Phone/Fax

Practice location:
  • Phone: 732-683-1800
  • Fax: 732-683-1090
Mailing address:
  • Phone: 732-683-1800
  • Fax: 732-683-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GERARD DEBERNARDIS
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 732-683-1800