Healthcare Provider Details

I. General information

NPI: 1376124115
Provider Name (Legal Business Name): CENTER FOR SPINE AND JOINT PAIN RELIEF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 HOOPER AVENUE BUILDING B 1ST FLOOR
TOMS RIVER NJ
08753-2586
US

IV. Provider business mailing address

1100 RT 70 WEST
WHITING NJ
08759-1003
US

V. Phone/Fax

Practice location:
  • Phone: 732-202-3000
  • Fax: 732-849-1511
Mailing address:
  • Phone: 732-202-3000
  • Fax: 732-849-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. DHARAM PAL MANN
Title or Position: PRESIDENT/ OWNER
Credential:
Phone: 732-849-0077