Healthcare Provider Details

I. General information

NPI: 1821630286
Provider Name (Legal Business Name): FRESH START MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 CLEVELAND AVE FL 1
HIGHLAND PARK NJ
08904-1817
US

IV. Provider business mailing address

7 KATHY ST
KENDALL PARK NJ
08824-1629
US

V. Phone/Fax

Practice location:
  • Phone: 732-249-6300
  • Fax:
Mailing address:
  • Phone: 732-310-7274
  • Fax: 732-960-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW JAY SPEESLER
Title or Position: DIRECTOR
Credential: MD
Phone: 732-249-6300