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General NPI Number Information
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NPI Number | 1407347875
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Entity Type | Organization
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Legal Business Name | CENTER FOR THE FUNCTIONAL RESTORATION OF THE SPINE LLC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 1131 BROAD ST STE 201
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4368
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Country | US
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Telephone | 732-380-1212
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Fax | 732-380-1372
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Provider Business Mailing Address
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Address Line | 1131 BROAD ST STE 201
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4368
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Country | US
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Telephone | 732-380-1212
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Fax | 732-380-1372
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Authorized Official
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Title or Position | PRACTICE ADMIN
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Name | MR. STEVEN ANTIERI
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Credential |
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Telephone | 732-380-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00662400
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License Number State | NJ
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