Healthcare Provider Details

I. General information

NPI: 1205121316
Provider Name (Legal Business Name): CENTER FOR JOINT AND SPINE RELIEF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 NEWARK AVE
JERSEY CITY NJ
07302-2736
US

IV. Provider business mailing address

218 NEWARK AVE
JERSEY CITY NJ
07302-2736
US

V. Phone/Fax

Practice location:
  • Phone: 201-533-0055
  • Fax: 201-533-0066
Mailing address:
  • Phone: 201-533-0055
  • Fax: 201-533-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00495100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00057300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA08003800
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA08003800
License Number StateNJ

VIII. Authorized Official

Name: DR. SERGE MENKIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-533-0055