Healthcare Provider Details

I. General information

NPI: 1073699385
Provider Name (Legal Business Name): MONMOUTH PAIN AND REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2006
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GLOBE CT
RED BANK NJ
07701-1824
US

IV. Provider business mailing address

7 GLOBE CT
RED BANK NJ
07701-1824
US

V. Phone/Fax

Practice location:
  • Phone: 732-345-1377
  • Fax: 732-936-9493
Mailing address:
  • Phone: 732-345-1377
  • Fax: 732-936-9493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00516600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS DANDREA
Title or Position: PRESIDENT
Credential: D.C.
Phone: 732-345-1377