Healthcare Provider Details

I. General information

NPI: 1275792277
Provider Name (Legal Business Name): BRUNSWICK SPINE & REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 STATE ROUTE 27
NORTH BRUNSWICK NJ
08902-1138
US

IV. Provider business mailing address

2300 STATE ROUTE 27
NORTH BRUNSWICK NJ
08902-1138
US

V. Phone/Fax

Practice location:
  • Phone: 732-821-9979
  • Fax:
Mailing address:
  • Phone: 732-821-9979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00617600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01136900
License Number StateNJ

VIII. Authorized Official

Name: DR. STANLEY J NOSAL III
Title or Position: CO-OWNER
Credential: D.C.
Phone: 732-821-9979