Healthcare Provider Details

I. General information

NPI: 1689166357
Provider Name (Legal Business Name): SIGNATURE HEALTH & WELLNESS JERSEY CITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GARFIELD AVE
JERSEY CITY NJ
07305-2432
US

IV. Provider business mailing address

2 GARFIELD AVE
JERSEY CITY NJ
07305-2432
US

V. Phone/Fax

Practice location:
  • Phone: 973-759-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH HILDERLEY
Title or Position: BILLING REPRESENTATIVE
Credential:
Phone: 352-683-3855