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General NPI Number Information
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NPI Number | 1275792277
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Entity Type | Organization
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Legal Business Name | BRUNSWICK SPINE & REHABILITATION PC
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 2300 STATE ROUTE 27
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-1138
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Country | US
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Telephone | 732-821-9979
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 STATE ROUTE 27
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-1138
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Country | US
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Telephone | 732-821-9979
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. STANLEY J NOSAL III
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Credential | D.C.
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Telephone | 732-821-9979
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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 | 40QA01136900
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License Number State | NJ
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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 | 38MC00617600
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License Number State | NJ
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