Healthcare Provider Details

I. General information

NPI: 1871844860
Provider Name (Legal Business Name): SPINE AND HEALTH CENTER OF JERSEY CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 SUMMIT AVE STE 501
JERSEY CITY NJ
07306
US

IV. Provider business mailing address

2520 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07304-2054
US

V. Phone/Fax

Practice location:
  • Phone: 201-761-0001
  • Fax: 201-918-6111
Mailing address:
  • Phone: 201-984-9055
  • Fax: 201-301-7395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC0062450
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER E WOHL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 201-984-9055