Healthcare Provider Details

I. General information

NPI: 1780036590
Provider Name (Legal Business Name): ALL CITY SPINE AND HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 UNION AVE SUITE 305
IRVINGTON NJ
07111-3277
US

IV. Provider business mailing address

40 UNION AVE SUITE 305
IRVINGTON NJ
07111-3277
US

V. Phone/Fax

Practice location:
  • Phone: 203-260-3476
  • Fax:
Mailing address:
  • Phone: 203-260-3476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00703500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number28MA008569300
License Number StateNJ

VIII. Authorized Official

Name: DR. EMMANUEL MARIE RENAUDO
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 203-260-3476