Healthcare Provider Details

I. General information

NPI: 1104165844
Provider Name (Legal Business Name): NEW JERSEY COMMUNITY SPINE AND PAIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 ROUTE 37 W
TOMS RIVER NJ
08755-5033
US

IV. Provider business mailing address

864 ROUTE 37 W
TOMS RIVER NJ
08755-5033
US

V. Phone/Fax

Practice location:
  • Phone: 732-503-4079
  • Fax: 732-503-4127
Mailing address:
  • Phone: 732-503-4079
  • Fax: 732-503-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: VINCENT V GIARDINA
Title or Position: OWNER
Credential: D.C.
Phone: 732-503-4079