Healthcare Provider Details

I. General information

NPI: 1780352625
Provider Name (Legal Business Name): PERFORMANCE HEALTH OF NEW JERSEY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2021
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 N CENTRAL AVE
RAMSEY NJ
07446-1864
US

IV. Provider business mailing address

46 N CENTRAL AVE
RAMSEY NJ
07446-1864
US

V. Phone/Fax

Practice location:
  • Phone: 888-926-1223
  • Fax:
Mailing address:
  • Phone: 888-926-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL R INGUI
Title or Position: CHAIRMAN
Credential: DC
Phone: 201-962-9066