Healthcare Provider Details

I. General information

NPI: 1013491232
Provider Name (Legal Business Name): PRECISION SPORTS AND SPINE WOODBRIDGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 US HIGHWAY 1
ISELIN NJ
08830-3152
US

IV. Provider business mailing address

675 US HIGHWAY 1
ISELIN NJ
08830-3152
US

V. Phone/Fax

Practice location:
  • Phone: 732-326-2348
  • Fax:
Mailing address:
  • Phone: 732-326-2348
  • Fax: 732-582-6936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. ANGELA M VIOLA
Title or Position: BILLER
Credential:
Phone: 732-772-3703