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General NPI Number Information
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NPI Number | 1528301868
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Entity Type | Organization
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Legal Business Name | NEW JERSEY INSTITUTE OF BALANCE, LLC
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 864 BROADWAY
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City | BAYONNE
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State | NJ
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Zip | 07002-3054
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Country | US
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Telephone | 201-339-1109
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Fax |
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Provider Business Mailing Address
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Address Line | 10 CHURCH TOWERS
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City | HOBOKEN
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State | NJ
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Zip | 07030
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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
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Name | MICHAEL S. RUSSO
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Credential | DPT
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Telephone | 201-339-1109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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