Healthcare Provider Details

I. General information

NPI: 1457410763
Provider Name (Legal Business Name): NORTH JERSEY SPINE AND SPORTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MARKET ST SUITE 1
SADDLE BROOK NJ
07663-5932
US

IV. Provider business mailing address

480 MARKET ST SUITE 1
SADDLE BROOK NJ
07663-5932
US

V. Phone/Fax

Practice location:
  • Phone: 201-843-8300
  • Fax: 201-843-7833
Mailing address:
  • Phone: 201-843-8300
  • Fax: 201-843-7833

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. JASON ERNEST WEBER
Title or Position: PRESIDENT
Credential: DC
Phone: 201-843-8300