Healthcare Provider Details

I. General information

NPI: 1225766603
Provider Name (Legal Business Name): INJURY CARE CENTER OF KEARNY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 KEARNY AVE
KEARNY NJ
07032-3005
US

IV. Provider business mailing address

715 KEARNY AVE
KEARNY NJ
07032-3005
US

V. Phone/Fax

Practice location:
  • Phone: 973-349-3350
  • Fax: 973-349-3351
Mailing address:
  • Phone: 973-349-3350
  • Fax: 973-349-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FERNANDO BARRESE
Title or Position: OWNER
Credential: DC
Phone: 973-349-3350