=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639668650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TLB HEALTH SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2018
-----------------------------------------------------
Last Update Date | 05/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 SANTORO CT
-----------------------------------------------------
City | BRANCHBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08876-5491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-595-5270
-----------------------------------------------------
Fax | 732-595-5443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 SANTORO CT
-----------------------------------------------------
City | BRANCHBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08876-5491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-595-5270
-----------------------------------------------------
Fax | 732-595-5443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRENDON A BEATRICE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 732-595-5270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 38MC00530500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------