Healthcare Provider Details

I. General information

NPI: 1750683132
Provider Name (Legal Business Name): PERTH AMBOY SPINE AND JOINT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SMITH ST
PERTH AMBOY NJ
08861-4413
US

IV. Provider business mailing address

75 SMITH ST
PERTH AMBOY NJ
08861-4413
US

V. Phone/Fax

Practice location:
  • Phone: 201-874-9084
  • Fax: 973-361-2721
Mailing address:
  • Phone: 201-874-9084
  • Fax: 973-361-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MS. DENISE PALLIS
Title or Position: BILLING MANAGER
Credential:
Phone: 201-874-9084