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General NPI Number Information
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NPI Number | 1003152299
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Entity Type | Organization
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Legal Business Name | CENTRAL JERSEY MEDICAL & CONSULTING, LLC
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 230 CENTENNIAL AVE
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City | CRANFORD
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State | NJ
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Zip | 07016-3137
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Country | US
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Telephone | 908-821-5390
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Fax |
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Provider Business Mailing Address
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Address Line | 760 RAVINE ROAD
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City | PLAINFIELD
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State | NJ
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Zip | 07062-3171
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Country | US
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Telephone | 908-462-2986
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | DR. GERALDINE MARIE BANDA
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Credential | D.C.
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Telephone | 908-462-2986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 38MC0274700
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License Number State | NJ
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