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General NPI Number Information
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NPI Number | 1215123641
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Entity Type | Organization
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Legal Business Name | CENTRAL JERSEY SPINE & WELLNESS L L C
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 4251 ROUTE 9 N BUILDING 3 SUITE B
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City | FREEHOLD
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State | NJ
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Zip | 07728-8303
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Country | US
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Telephone | 732-683-1800
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Fax | 732-683-1090
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Provider Business Mailing Address
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Address Line | 4251 ROUTE 9 N BUILDING 3 SUITE B
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City | FREEHOLD
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State | NJ
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Zip | 07728-8303
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Country | US
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Telephone | 732-683-1800
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Fax | 732-683-1090
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. GERARD DEBERNARDIS
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Credential | DC
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Telephone | 732-683-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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