Healthcare Provider Details

I. General information

NPI: 1356840524
Provider Name (Legal Business Name): SPINE AND SPORTS THERAPY OF NEW JERSEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOURNAL SQUARE PLZ STE 303
JERSEY CITY NJ
07306-4004
US

IV. Provider business mailing address

1 JOURNAL SQUARE PLZ STE 303
JERSEY CITY NJ
07306-4004
US

V. Phone/Fax

Practice location:
  • Phone: 914-376-6100
  • Fax: 914-470-5056
Mailing address:
  • Phone: 914-376-6100
  • Fax: 914-470-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MELISSA NIELI
Title or Position: BILLING MANAGER
Credential:
Phone: 914-376-6100