Healthcare Provider Details

I. General information

NPI: 1023403722
Provider Name (Legal Business Name): NEW JERSEY SPINE AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/10/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 HAMBURG TPKE STE 203A
WAYNE NJ
07470-8446
US

IV. Provider business mailing address

61 LAKE TRL E
WAYNE NJ
07470-4447
US

V. Phone/Fax

Practice location:
  • Phone: 973-747-6346
  • Fax:
Mailing address:
  • Phone: 908-770-1325
  • Fax:

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. NICHOLAS A CAROFILIS
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 973-747-6346