Healthcare Provider Details

I. General information

NPI: 1598012486
Provider Name (Legal Business Name): NJ COMMUNITY SPINE AND PAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 ROUTE 37 W SUITE 1
TOMS RIVER NJ
08755-5033
US

IV. Provider business mailing address

864 ROUTE 37 W SUITE 1
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 State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. VINCENT GIARDINA
Title or Position: OWNER
Credential: DC
Phone: 732-503-4079