Healthcare Provider Details

I. General information

NPI: 1588444160
Provider Name (Legal Business Name): DYNAMIC PAIN SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 JOHN F KENNEDY BLVD FL 1
JERSEY CITY NJ
07306-3682
US

IV. Provider business mailing address

3049 JOHN F KENNEDY BLVD FL 1
JERSEY CITY NJ
07306-3682
US

V. Phone/Fax

Practice location:
  • Phone: 201-222-6042
  • Fax: 201-222-5194
Mailing address:
  • Phone: 201-222-6042
  • Fax: 201-222-5194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. RALPH MAYSON SCIANNI
Title or Position: CHIROPRACTOR/PARTNER
Credential: DC
Phone: 201-600-9946