Healthcare Provider Details

I. General information

NPI: 1447930862
Provider Name (Legal Business Name): BACK AND BODY MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E BROAD ST
WESTFIELD NJ
07090-2190
US

IV. Provider business mailing address

505 E BROAD ST
WESTFIELD NJ
07090-2190
US

V. Phone/Fax

Practice location:
  • Phone: 908-233-4200
  • Fax: 908-233-9020
Mailing address:
  • Phone: 908-233-4200
  • Fax: 908-233-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SOKRATIS G DRAGONAS
Title or Position: OWNER
Credential: DC
Phone: 908-233-4200