Healthcare Provider Details

I. General information

NPI: 1750872719
Provider Name (Legal Business Name): PATERSON CHIROPRACTIC AND PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BROADWAY FL 1
PATERSON NJ
07501-2102
US

IV. Provider business mailing address

PO BOX 503
SADDLE BROOK NJ
07663-0503
US

V. Phone/Fax

Practice location:
  • Phone: 973-345-2800
  • Fax:
Mailing address:
  • Phone: 973-345-2800
  • Fax: 973-345-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number38MC0052900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL MANNO
Title or Position: OWNER
Credential: DC
Phone: 973-345-2800