Healthcare Provider Details

I. General information

NPI: 1881764421
Provider Name (Legal Business Name): PREMIER SPINE & SPORTS REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MORRIS TPKE
SHORT HILLS NJ
07078-2614
US

IV. Provider business mailing address

PO BOX 510
CHATHAM NJ
07928-0510
US

V. Phone/Fax

Practice location:
  • Phone: 973-467-4444
  • Fax: 973-467-4446
Mailing address:
  • Phone: 973-467-4444
  • Fax: 973-467-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC004002800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00025700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA04770900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00915800
License Number StateNJ

VIII. Authorized Official

Name: RICK DEBIASI
Title or Position: OWNER
Credential: DC
Phone: 973-467-4444