Healthcare Provider Details

I. General information

NPI: 1588102867
Provider Name (Legal Business Name): ACCESS PAIN & SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 LAFAYETTE AVE
HAWTHORNE NJ
07506-1904
US

IV. Provider business mailing address

219 LAFAYETTE AVE
HAWTHORNE NJ
07506-1904
US

V. Phone/Fax

Practice location:
  • Phone: 973-423-9100
  • Fax: 973-423-1339
Mailing address:
  • Phone: 973-423-9100
  • Fax: 973-423-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00452800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER JOSEPH BERGER
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 973-423-9100