Healthcare Provider Details

I. General information

NPI: 1356737506
Provider Name (Legal Business Name): SRS 3 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 CENTRAL AVE
WESTFIELD NJ
07090-5625
US

IV. Provider business mailing address

812 CENTRAL AVE
WESTFIELD NJ
07090-5625
US

V. Phone/Fax

Practice location:
  • Phone: 908-232-5595
  • Fax: 908-654-9286
Mailing address:
  • Phone: 908-232-5595
  • Fax: 908-654-9286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00337800
License Number StateNJ

VIII. Authorized Official

Name: DR. SALVATORE RICHARD SANTANGELO
Title or Position: OWNER
Credential: D.C.
Phone: 908-232-5595