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General NPI Number Information
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NPI Number | 1215236161
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Entity Type | Organization
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Legal Business Name | COMMUNITY SPINE & PAIN CENTER
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Dates
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Enumeration Date | 03/17/2011
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Last Update Date | 03/17/2011
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Provider Practice Location Address
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Address Line | 833 RTE 37 W
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City | TOMS RIVER
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State | NJ
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Zip | 08755-5038
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Country | US
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Telephone | 732-580-4186
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Fax |
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Provider Business Mailing Address
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Address Line | 833 RTE 37 W
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City | TOMS RIVER
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State | NJ
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Zip | 08755-5038
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Country | US
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Telephone | 732-580-4186
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KENNETH LEWANDOWSKI
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Credential | D.O.
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Telephone | 732-580-4186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00479700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MB57910
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License Number State | NJ
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