Healthcare Provider Details

I. General information

NPI: 1467522235
Provider Name (Legal Business Name): CENTER FOR EVALUATION AND TREATMENT OF NEUROMUSCULAR AND ORTHOPEDIC DI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 PALISADE AVE
JERSEY CITY NJ
07306-1133
US

IV. Provider business mailing address

191 PALISADE AVE
JERSEY CITY NJ
07306-1112
US

V. Phone/Fax

Practice location:
  • Phone: 201-656-4324
  • Fax:
Mailing address:
  • Phone: 201-656-3647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number33984
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number33984
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number33984
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number33984
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number33984
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number33984
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number33984
License Number StateNJ
# 8
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number33984
License Number StateNJ
# 9
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number33984
License Number StateNJ
# 10
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number33984
License Number StateNJ
# 11
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number33984
License Number StateNJ
# 12
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number33984
License Number StateNJ
# 13
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number33984
License Number StateNJ

VIII. Authorized Official

Name: DR. MONICA MEHTA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 201-656-4324