=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235856188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTOWA SPINE & INJURY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2022
-----------------------------------------------------
Last Update Date | 10/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 547 UNION BLVD
-----------------------------------------------------
City | TOTOWA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07512-2404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-512-2100
-----------------------------------------------------
Fax | 973-512-2150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 54 LEWIS PL
-----------------------------------------------------
City | TOTOWA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07512-2648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-885-8877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JORGE DE LA TORRE JR.
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 973-512-2100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------