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General NPI Number Information
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NPI Number | 1306231527
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Entity Type | Organization
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Legal Business Name | ELITE SPINE AND SPORTS CARE OF TOTOWA
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 351 UNION BLVD
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City | TOTOWA
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State | NJ
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Zip | 07512-2556
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Country | US
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Telephone | 862-239-1768
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 688
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City | TOTOWA
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State | NJ
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Zip | 07511-0688
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | GABRIEL HANNAWI
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Credential | D.C.
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Telephone | 862-239-1768
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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 | 38MC00715100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01425800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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