Healthcare Provider Details

I. General information

NPI: 1639401896
Provider Name (Legal Business Name): NEWARK PAIN AND REHAB CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MCWHORTER ST
NEWARK NJ
07105-6023
US

IV. Provider business mailing address

PO BOX 32177
NEWARK NJ
07102-0577
US

V. Phone/Fax

Practice location:
  • Phone: 973-344-0012
  • Fax: 973-344-0898
Mailing address:
  • Phone: 973-344-0012
  • Fax: 973-344-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC005914
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00613400
License Number StateNJ

VIII. Authorized Official

Name: DR. VINCENT SARACENO
Title or Position: OWNER
Credential: D.C.
Phone: 973-344-0012